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Microbiology · Virology: avian influenza
Sample itemIn an outbreak of poultry deaths, a poultry farm worker develops fever, cough and rapidly progressive breathlessness with bilateral infiltrates. Avian influenza A(H5N1) is suspected. What is the most appropriate antiviral approach?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Start oseltamivir immediately without awaiting confirmation
Neuraminidase inhibitors such as oseltamivir reduce mortality if started early and should be given empirically in suspected avian influenza, with confirmation by RT-PCR on respiratory samples. Adamantanes are not recommended because circulating H5N1 and most influenza A strains are resistant. Aciclovir and ribavirin are not effective for influenza.
Option by option
A. Start aciclovir pending confirmation
Aciclovir acts on herpesviruses and has no effect on influenza virus.
B. Start amantadine, as the H5N1 virus is usually susceptible
Most circulating influenza A viruses, including H5N1, are resistant to amantadine.
C. Start ribavirin alone
Ribavirin is not an established treatment for avian influenza.
D. Start oseltamivir immediately without awaiting confirmation (correct)
Correct. Early oseltamivir is the treatment, and testing should not delay it.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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