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Respiratory Viral Ilnesses

Marshell Tendean
Department of Internal Medicine
UKRIDA Jakarta

 Respiratory viral ilnessess notably as most common human


 Approximately one half among human disese.

 Adult can have 3-4 cases per year

 Causes for drug abuse among adults

 Among 2/3 caused by virus

The Course of Disease :

 Common cold
 Pharyngitis
 Croup
 Tracheitis
 Bronchiolitis
 Bronchitis
 Pneumonia
Ilness Associated with Respiratory

aSARS-associated coronavirus (SARS-CoV) caused epidemics of pneumonia from November 2002 to July 2003 (see text).
bSerotypes 4 and 7.
cFever, cough, myalgia, malaise.
dMay or may not have a respiratory componen
Influenza virus :

 RNA, Othromyxoviridae

 Affects
birds and
mamals, and
 Calledas flu or 24 h flu
or stomach flu
 Influenzaviruses can be
inactivated by sunlight,
disinfectants and
Influenza Virus :

 Influenza A

 Influenza B

 Influenza C

CDC. Influenza virus

Pathomechanism :

 Antigenic shift : small gradual changes in antibody-binding

sites HA, and NA of a virus that enable the resistancy against
earlier strain
 Occurs in both type A and B viruses

 Antigenic shift: an abrupt major change that cause a novel

influenza A virus that had not previously circulated
 Occurs only in influenza A
 Can use wide or severe outbreaks or pandemic
History of Pandemics :

 Bird flu or Avian flu

 Swine flu in 2009

 H1N1, which caused Spanish Flu in 1918

 H3N2, which caused Hong Kong Flu in 1968

 H2N2, which caused Asian Flu in 1957


 Influenza A has 18 distinct H subtypes and 11 distinct N

subtypes, of which only Hl, H2, H3, Nl, and N2 have been
associated with epidemics of disease in humans.

 Influenza B and C have molecular similarities but less

intratypic variation, and not occur in influenza C virus.
Symptoms :

 Headache, feverishness, chills, myalgia, and malaise.

 Respiratory tract signs and symptoms, particularly cough and

sore throat.
Target populations for treatment

 Individuals with severe disease (requiring hospitalization or

evidence of lower respiratory tract infection) or at high risk
for complications should receive antiviral therapy. Antiviral
therapy, when indicated, should be initiated as promptly as
Laboratory Examination :

 Virus may be detected in throat swabs, naso pharyngeal

swabs or washes, or sputum.
 Reverse-transcriptase polymerase chain reaction (RT-PCR) is the
most sensitive and specic technique for detection of influenza
 Rapid influenza diagnostic tests (RIDTs) detect influenza virus
antigens by immunologic or enzymatic techniques
 Virus isolation and culture
 Serology
Antiviral drugs :

 The neuraminidase inhibitors, zanavir and oseltamivir, active

against influenza A and influenza B.

 The adamantanes, amantadine and rimatadine, active against

influenza A.
Complications :

 Pulmonary :
 Primary influenza viral pneumonia
 Secondary pneumonia
 Mixed viral influenza pneumonia

 Extrapulmonary :
 Myositis
 Rhabdomyolisis
 Myoglobinuria
 CNS complications
 Toxic shock syndrome
Prevention :

 Vaccination :
 Attenuated vaccine
 Inactivated vaccine

 Chemoprophylaxis:
 “considered for individu als at high risk of complications who
have had close contact with an acutely ill person with influenza”
 Antiviral chemoprophylaxis can be administered simultaneously
with inactivated vaccine.