Академический Документы
Профессиональный Документы
Культура Документы
Scott Lippacher
Helen McDonald
State University of New York Polytechnic
Institute
Influenza
Acute Respiratory illness
Acutely debilitating but self-limiting
Outbreaks and epidemics mainly in winter
Increased mortality in high-risk populations
Pay close attention to local epidemiology and outbreaks
Pathophysiology
Influenza viruses are single stranded RNA virus
There are 3 types of the virus, A,B and C
Influenza A infects birds, pigs, horses, and humans and is
Pathophysiology- cont.
Hemagglutinin and Neuraminidase are 2 proteins needed
Pathophysiology, cont.
Mutates easily, with influenza A mutating 300 times
Etiology
Respiratory secretions from infected persons
Aerosolized small particle respiratory droplets
Sneezing, coughing
Large particle droplets (up to 6 feet)
Droplets land in mouth/nose of recipient
Less frequently contaminated surfaces
Incidence
Seasonally episodic
More than 20,000 cases every year in the U.S
Screening
History and physical
Awareness of community and institutional outbreaks
Rapid influenza diagnostic tests
Reverse transcription polymerase chain reaction (RT-
PCR)
Diabetes mellitus
Sickle cell
Immunosuppression
Neurological
conditions
(Zachary, 2015)
Clinical Findings
Cough, chest pain, dyspnea
Fever- low or high grade
Myalgias- mild to severe
Headache- Severe frontal and retro-orbital
Rhinorrhea- mild if any
Fatigue- can be severe
Sore throat- may be severe, commonly the symptom
Differential Diagnosis
Infectious mononucleosis
Coxsakievirus infection
Viral/streptococcal tonsillitis
Atypical Mycoplasma pneumonia
Respiratory viral infection
Syncytial virus
Parainfluenza
Adenovirus
Enterovirus
(Domino et al., 2013)
Social/Environmental
Usually can be handled by the available health care
institutions
People with chronic illness are at the highest risk for
increased morbidity and mortality
Between 3,000 and 49,000 deaths per year over the last
30 years in the U.S.
Laboratory/Diagnostics
Gold standard polymerase chain reaction from
False-positives
more likely
when community disease
prevalence is low, beginning
and end of season
False-negative more likely
when community disease
prevalence is high during flu
season
Reduce false results
Collection of specimen within 34 days of illness onset
Consider sending RT-PCR to
confirm result of rapid test
Management/Treatment
Non-pharmacological
Handwashing- soap and
Limit contact
Rest and fluids
Avoid smoking
Humidifier
Symptomatic treatment
Saline nasal spray
Analgesic gargle
May need hospitalization for IV
Management/Treatment
Pharmacological
Vaccination-prevention
Inactivated, live attenuated and recombinant
Quadravalent
Trivalent
Antiretrovirals
Oseltamivir
Zanamivir
Peramivir
(CDC, 2014)
Primary prevention
Intramuscular
Nasal Spray
Ages 2-49 years
during pregnancy
Contraindications to vaccine
Children younger than 6 months
Severe, life-threatening allergy
to vaccine or any of its
ingredients
History of Guillain-Barre
Syndrome
Fever
(CDC, 2015c)
Complications
Pneumonia
Most common
Frequently in high risk populations
Primary viral (influenza) PNA
Most severe, least common
Influenza directly involves lungs producing severe PNA
High fever, dyspnea, cyanosis
Muscle
Myositis and rhabdomyolysis- most frequently in children
(Dolin, 2015a)
Complications
Central nervous system
Encephalopathy, encephalitis, transverse myelitis, aseptic
meningitis, Guillain-Barre syndrome
Toxic shock syndrome
Cardiac
ECG changes
MI
Ischemic heart disease
Myocarditis and pericarditis (rare)
(Dolin, 2015a)
Follow up
Follow up depends on the patient symptoms and
Counseling/Education
Primary prevention
Influenza vaccine every year, especially in high risk populations
Pneumonia vaccine to minimize secondary infection
Hand Hygiene
Course of illness
Avoid school/work for 24 hours after fever subsides
Cough etiquette
Usage of masks
Resist touching eyes, mouth or nose to reduce transmission
Limit contact
Rest and fluids
Avoid smoking
Humidifier
Consultations
Infectious Disease specialist may be considered
Intensivist may be required depending on the severity
If the H1N1 variety, Pulmonologist, Intensivist, ID, and the
Questions
1. How many cases of seasonal flu are there in a year?
a. 3,000
b. 20,000
c. 49,000
2. Sore throat is the common reason that patients present
to healthcare with the flu.
a. true
b. false
Answers
1. B
2. A
3. B
4. A
5. C
6. B
7. D
8. B
9. C
10.D
References
Centers for Disease Control and Prevention. (2014). How the Flu Virus Can Change:
Drift and Shift. Retrieved October 12, 2015, from
http://www.cdc.gov/flu/about/viruses/change.htm
Center for Disease and Prevention. (2015a). Guidance for clinicians on the use of
rapid influenza diagnostic tests. Retrieved
fromhttp://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm#figure1
Center for Disease and Prevention. (2015b). How flu spreads. Retrieved from
http://www.cdc.gov/flu/about/disease/spread.htm
Center for Disease and Prevention. (2015c). Key facts about seasonal flu vaccine.
Retrieved from http://www.cdc.gov/flu/protect/key facts.htm
Center for Disease and Prevention. (2015d). Rapid diagnostic testing for influenza:
information for health care professionals retrieved from
http://www.cdc.gov/flu/professionals/diagnosis/rapidclin.htm
Derlet, R., Nguyen, H., & Sandrock, C. (2015, September 29). Influenza. Retrieved
October 12, 2015, from http://emedicine.medscape.com/article/219557-overview#a5
Dolin, R. (2015a). Clinical manifestations of seasonal influenza in adults. Retrieved
from
http://www.uptodate.com/contents/treatment-of-seasonal-influenza-in-adults?source
=search_result&search=influenza&selectedTitle=1%7E150
References Cont.
Dolin, R. (2015b). Diagnosis of seasonal influenza in adults. Retrieved
fromhttp://www.uptodate.com/contents/diagnosis-of-seasonal-influenza-in-adults?topicKey=ID
%2F15871&elapsedTimeMs=1&source=search_result&searchTerm=influenza+screen&selecte
dTitle=1%7E150&view=print&displayedView=full#
Domino, F. J., Baldor, R. A., Golding, J., Grimes, J. A., & Taylor, J. S. (2013). The 5-minute
clinical consult 2013. Philladelphia, PA: Lipplincott
Goodsell, D. S. (2006). Hemagglutinin. RCSB Protein Data Bank.
http://doi.org/10.2210/rcsb_pdb/mom_2006_4
Goodsell, D. S. (2009). Influenza Neuraminidase. RCSB Protein Data Bank.
http://doi.org/10.2210/rcsb_pdb/mom_2009_5
Public Health Agency of Canada. (2011, February 18). Influenza Virus Type A. Retrieved from
ww.phac-aspc.gc.ca/lab-bio/res/psds-ftss/influenza-a-eng.php
Public Health Agency of Canada. (2012, April 30). Influenza Virus (B and C). Retrieved from
http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/influenza-grippe-b-c-eng.php
U.S. Department of Health & Human Services. (n.d.). About Pandemics. Retrieved November
1, 2015, from http://www.flu.gov/pandemic/about/
Zachary, K. (2015). Treatment of seasonal influenza in adults. Retrieved from http://
www.uptodate.com/contents/treatment-of-seasonal-influenza-in-adults?source=search_result
&search=influenza&selectedTitle=1%7E150