Management of symptoms in adult patients with infectious diseases – Reasons to be different?

In adult inpatient Clinical Infectious Diseases practice, symptoms are important because they guide diagnosis and demonstrate treatment response. However, they also cause distress - hence symptom management is an important part of holistic treatment. Whereas treatment guidelines for management of the infection are focused and easily-accessible, management guidelines for symptoms are non-specific and widely-dispersed in the non-infection literature. In this Practical Clinical Review we identify infection-specific aspects of symptom management and collate relevant literature in one place. We do this by addressing two questions: (i) What symptoms present most frequently in Clinical Infectious Disease practice and (ii) Should symptoms in infection be managed differently from other settings? To assess frequency, we used point-prevalence data from two clinical service evaluations on an adult Infectious Diseases ward, scoring symptoms for severity and treatments for efficacy. The most reported symptoms then formed the template for a narrative literature review. One hundred participants reported 275 symptoms. The six most-frequently reported (> 10x each) were pain, fever, breathlessness, headache, tiredness/fatigue and cough. All scored similarly high values for severity but treatment efficacy scored lowest for pain. The literature review identified several infection-specific features of symptom management. For pain, although paracetamol represents the analgesic of choice, use in viral hepatitis should be cautious. Non-steroidal anti-inflammatory drugs exacerbate bacterial soft-tissue infections, especially in varicella zoster, and exacerbate renal toxicity. Opioids may increase infection rates and mask infection-related ‘warning signs’. For post-dural puncture headache, evidence does not favour caffeine use. Fever should be treated to manage distress, not to achieve specific temperature targets, except when very high. Breathlessness, appears most effectively managed by high-flow nasal cannulae. Tiredness is common; excessive exertion should be avoided but rehabilitation should be early and progressive unless viral myocarditis is a risk. Infection-specific symptom management issues should be considered in adult Infectious Diseases practice.