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Report on influenza – ethiology, epidermiology, pathogenesis, treatment

Ethiology - caused by influenza virus – orthomixoviridae family – 3 types A,B,C – single stranded RNA . 8
pieces.
Influenza A has 2 main surface antigens – Haemaglutin (H) & Neuraminidase (NA).
(H)- responcible for cell attachment to host cell and agglutination of RBC further divided into H1,H2,H3.
(NA) – Prevent self aggregation and promoting dispersion during budding of new virions from the infected
cell.
Responsible for receptor destruction. Divided into N1,N2.
Epidermiology – transmitted by humans, thru respiratory droplets. IP – 6hrs- 2day
Antigenic shift – occurs when major change in antigenic type H2N2—H3N3 occurs due to new RNA
segments and are the reason for major pandemics. Antigenic drift – relatively frequent minor changes in
antigenic type H / N this is due to small mutations in RNA segments.
Pathogenesis – Transmission via droplet inhalation – virus binds to respiratory epithelium – replication – cell
death
(Further NA decrease viscocity of mucos & damage of ciliary columnar epithelium – virus & exudative fluid
go to lower respiratory tract causing complication of viral / bacterial mixed pneumonia.)
clinical features- younger children-croup, bronchiolitis ,bronchitis, mild pneumonia. Older children,
adolescents, adults I.B6hr-2days(a) Fever(38.4C),headache, myalgia, chills, malaise (b)Respiratoy-dry
cough,sore throat, nasal congestion. Trachitis (burning, itching, non productive cough)
(c) ocular -photophobia, tearing, conjunctivitis.(d)meningismus (intoxication) (e) petechias in skin mucus,
visaral organs
Complications
1. pneumonia viral/ bacterial. H.influansa, staph. aureus, Step pneumonia
2. Reyes syndrome- has occurred in 2-10 yrs old children who have use Asprine
(1) sudden onset of nausea, vomiting for 1-2 days followed by neurological symptoms lethargy, confusion,
coma (2) hepatomegaly, ALAT, ASAT, LDH increased. bilirubin-N no jaundice (3)blood ammonia
,hypoglycaemia (4) liver biopsy- fatty infiltration of hepatocytes (5) CNS- cerebral oedema CSF P increased
indicate encephalopathy (death due to increased intercranial pressure) (Other conditions that lead to Reyes
chicken pox ,EBV, entero) 3.Myositis 4. Myocarditis
5 Guillain barre syndrom –can happen a/f any viral infection, allergie or autoimmune reaction to virus Clinics
(1)febrile stage-fever headache, body aches (2) latent stage- symp. disappar and is normal for 1-4wk (3)
paralytic stage-acute severe weakness or paralysis starting from LL goes to trunk – respiratory m. UL
weakness more in proximal than distal m. , cranial VII,X involment leading to facial paralysis.
Diagnosis – throat swab – RIA, ELISA, haemagglutination inhibition, compliment fixation. Blood test -
(double antibody test) 1st antibody test 7 days after 1st symptom, 2nd antibody test 10-14 days If titer >x4.-
(+)Blood test – if bacteria complicated increased ESR , leucocytosis if only influenza – leucopenia , relative
lymphocytosis ,sputum for smear grams stain-examine for leucocytes & bac.
Treatment – Ethiological –Amantadine, Remantadine 1st day 300mg, 2nd day 200mg, 3rd day 100mg (1 tab
50mg)-mostly for A. Pathological –glucose vit –C.Symptamatic-Analgertics,Antipyretics(declofenac)
.Relanza-(for influ-A B) two to 4 sprays –3 days.
Profilaxis 1.vaccination yearly b/c antigenic shift occurs these are only against A&B.2. Remantadine 50mg(1
tab day)for 5days vac. is given to all risk patients.
Dif/ Dig of infuenza
1.All other virus infec.2. T.B.C 3.Classic bac.phemonia. 4. Urogenital infc. 5. Viral hepatitis A 6. malaria
7.dangue 8.sepsis 9.E.B.V
Complication –phumonia
Viral pheumonia
1st day develop/Can be cough with blood,tachypnoea,resp. insufficacy/ diffuse bilateral /Therapy
Remantadine,Amantadine,Relanza
Bac. Pheumoia
Deve.later 7 day/ sputum with pus / unilateral- lobar / Therapy Remantadien –3days /Amoxicilln ,amoxiclar
7days or 7-14 days
 Report on influenza – ethiology, epidermiology, pathogenesis, treatment

Report prepared by
1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.
2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.
3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania.

Contact: publications [at] infekcijas.eu