TASHKENT MEDICAL ACADEMY Department of infectious and pediatric

TASHKENT MEDICAL ACADEMY Department of infectious and pediatric infectious diseases Acute viral respiratory infections and influenza Reader: Candidate of Medical Science, associate professor, Niyazova T. A.

Counsel: 1. Introduction – 5 min. 2. Historical data – 5 min. 3. Etiology and epidemiology – 10 min. 4. Pathogenesis and pathological anatomy – 10 min. 5. Clinical findings – 30 min. 6. Diagnosis – 8 min. 7. Treatment measures – 10 min. 8. Preventive measures – 7 min. 9. Conclusion – 5 min.

INFLUENZA n Influenza, commonly referred to as the flu or grippe, is an acute, highly contagious infection of the respiratory tract, results from three different types of Myxovirus influenzae.

ETIOLOGY n n Pathogenic organism (agent) - RNA virus of the family Orthomyxoviridae, size of virus – 80 -120 nm; In virus classification influenza viruses are RNA viruses that make up three of the five genera of the family Orthomyxoviridae: Influenzavirus A, B, C; The type A viruses are the most virulent human pathogens and genetic changeable among the three influenza types; Changeability of virus is showed by changing of superficial antigens: - hemagglutinin (Н); - neuraminidase (N).

Viruses of influenza

Epidemiology n n n Large epidemics of influenza A arise in the range from 2 to 3 years, pandemics arise in the range from 10 to 15 years; Type B also strikes annually but causes epidemics only every 4 to 6 years; Type C is endemic and causes only sporadic cases; Source of infection is sick person, particularly at the height of the disease (4 -7 days of illness); Transmission of influenza occurs through of a respiratory droplet from an infected person or by indirect contact, such as the use of a contaminated drinking glass; Although influenza affects all age-groups, its incidence is highest in schoolchildren.

Known flu pandemics NAME OF PANDEMIC DATE Asiatic (Russian) 1889– 1890 Flu 1918 flu pandemic (Spanish flu) Asian Flu DEATHS 1 million CASE SUBTYPE FATALITY INVOLVED RATE possibly 0. 15% H 3 N 8 1918– 1920 20 to 100 million 2% H 1 N 1 1957– 1958 1 to 1. 5 million 0. 13% H 2 N 2 Hong Kong Flu 1968– 1969 0. 75 to 1 million <0. 1% H 3 N 2 2009 flu pandemic 2009– 2010 18, 000 0. 03% H 1 N 1

Epidemiology

Epidemiology

Pathogenesis (by Kethiladze Е. S. ) : n n n Reproduction of viruses in epithelial cells of mucous membrane of respiratory tract; Virusemia, toxic and toxic-allergic reaction of organism; Causing inflammation and desquamation; Bacterial complications of respiratory tract and other organs; Decrease of pathological process and change-over to recovery.

Pathogenesis

Symptoms of influenza n n n Symptoms of influenza can start quite suddenly one to two days after infection; Usually the first symptoms are chills or a chilly sensation, but fever is also common early in the infection, with body temperatures ranging from 38 -39 °C; Many people are so ill that they are confined to bed for several days, with aches and pains throughout their bodies, which are worse in their backs and legs.

Symptoms of influenza may include: n n n n Fever and extreme coldness (chills shivering, shaking (rigor)); Cough, nasal congestion; Body aches, especially joints and throat; Fatigue, headache; Irritated, watering eyes; Reddened eyes, skin (especially face), mouth, throat and nose; In children, gastrointestinal symptoms such as diarrhea and abdominal pain.

Clinical findings

Clinical findings

Clinical findings. Conjunctivitis.

Injections of vessels and enanthemas

Hemorrhagic pneumonia

Fibrinogenousnecrotic laryngotracheobronchitis

Segmental inflammation

COMPLICATIONS n n n Pneumonia; Rhinitis, pharyngitis, laryngitis, tracheobronchitis, locular and ва follicular quinsy, antritis, frontal sinusitis, ethmoiditis, otitis and others; Meningitides, meningo-encephalitis, arachnoiditis, polyneuritis, radiculitis.

DIAGNOSTICS 1. 2. 3. 4. Clinical findings; Viral investigations; Serologic investigations (RTGA, Reiter's complement fixation test, (R)CFT, RNGA); Immune-enzyme analysis.

DIFFERENTIAL DIAGNOSTICS n n n n Epidemic spotted fever, Brill's [Brill-Zinsser] disease; Typhoid (enteric) fever and paratyphoid А , В; Meningococcal infectious; Tuberculosis meningitis; Aseptic [serous] meningitis; Tick-borne [vernal] encephalitis; Poliomyelitis; Infectious mononucleosis; Hepatitis А; Brucellosis; Q-fever; Ornithosis; Measles; Scarlet fever; Malaria.

TREATMENT n n n Regimen; Diet; Etiological treatment; Pathogenetic treatment; Symptomatic treatment.

ETIOLOGICAL TREATMENT n The two classes of antiviral drugs used against influenza are neuraminidase inhibitors and M 2 protein inhibitors: n Neuraminidase inhibitors – oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza); n M 2 inhibitors (adamantanes) amantadine and rimantadine.

PROPHYLAXIS n n n Isolation of sick (patient); Separate all plates and dishes used by sick (patient); Во время эпидемии гриппа запретить частое собрание многих людей в помещение; All people must wear gauze mask; Specific preventive measures (vaccination) should be carry out at the beginning of epidemic.

PROPHYLAXIS Type of influenza vaccine

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