Hanan Ibrahim Fatal Flu

8/14/2019 Hanan Ibrahim Fatal Flu

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A 6 years old previously healthy boy with

extensive pneumonia.

Rapidly progressing ARDS.

CRP and CBC shows no signs of bacterial

sepsis.

Leucopenia, lymphopenia.


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Bacterial Pneumonia:CRP-ve

CBC parametersNo response to aggressive

antibiotic therapy


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Atypical PneumoniaThe "atypical" bacteria are Coxiella burnetti,

Chlamydophila pneumoniae , Mycoplasma pneumoniae ,

and Legionella pneumophila.

They are "atypical" because they commonly affect

teenagers and young adults, are less severe, and require

different antibiotics than typical bacteria such as

Streptococcus pneumoniae.
http://en.wikipedia.org/wiki/Atypical_pneumoniahttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Atypical_pneumoniahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Atypical_pneumonia


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Viral PneumoniaFlu preceding pneumonia

V. raped course

CBC parameters

No response to antibiotics


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Viruses that commonly cause pneumonia include:

Influenza virus A and B(Avian Flu, Swine Flu)

Respiratory syncytial virus (RSV)

Adenoviruses (in military recruits)

Metapneumovirus

Human parainfluenza viruses (in children)Corona Virus (SARS)

Hanta Virus

Rhino Virus

Viruses that rarely cause pneumonia include:

Herpes simplex virus (HSV), mainly in newbornsVaricella-zoster virus (VZV)

Cytomegalovirus (CMV), mainly in people with immune system

problems
http://en.wikipedia.org/wiki/Influenza_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Influenza_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Influenza_virus


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Viruses account for the largest proportion ofchildhood pneumonia; viruses decrease in

frequency as the etiology of pneumonia in healthy

adults, and once again become frequent causes of

death and morbidity in persons older than 60

years.

Viral pneumonia can vary from a mild illness to a

life-threatening disease with respiratory failure,severe hypoxemia, and ARDS.


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Viruses associated with severepneumonia and ARDS

-Influenza Virus-Corona Virus(SARS)

-Adeno Virus-Metapneumovirus

-Hanta Virus


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Human MetapneumovirusHMNV,a respiratory virus identified in 2001, is

emerging as one of the most common causes of

serious lower respiratory tract illness in children

allover the world.

It belongs to Paramyxoviridae family.

HMNV outbreaks in annual epidemics (late winterand early spring ).

C.P. is similar to the profile of RSV.

Young age is a major risk of severe illness.


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AdenovirusAdenoviruses are medium-sized (90-100 nm),nonenveloped icosohedral viruses containing double-

stranded DNA.

There are 51 immunologically distinct types (6subgenera: A through F) that can cause human

infections.


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Clinical Syndromes by Adenoviruses

-Acute Respiratory DiseasePharyngitis

Pneumonia

pertussis-like syndome

pharyngoconjunctival fever

-Conjunctivitis and keratoconjunctivitis(Pink Eye Syndrome)

-Myocarditis

-Gastrointestinal Infections

-Hemorrhagic cystitis

-Reye Syndrome and Reye-like Syndrome


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Severe Pneumonia andARDS

are most often associated withadenovirus types 3, 7,and 21 .

Such infections have highmortality, and residual airway

damage.


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Killer Cold Virus: Adenovirus Infection (Ad14)

A rare strain of a cold virus, known as adenovirus type 14

(Ad14), has caused severe and even fatal respiratory

illness in healthy children and adults.

Infection with the virus seems to be becoming morecommon in the United States, according to officials from

the U.S. Centers for Disease Control and Prevention

(CDC).


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This virus is different from other adenoviruses that cause

the common cold in that it may produce an unusuallysevere illness requiring intensive medical care.

Although the Ad14 strain was identified in the 1950s, the

variant that was isolated in 2006 and 2007 is genetically

different from the original Ad14, suggesting that the viralgenetic material has undergone mutations (changes)

that have resulted in the increased severity of infections

with Ad14.


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Severe acute respiratorysyndrome

SARSis a respiratory disease in humans which is caused by theSARS coronavirus (SARS-CoV).There has been one near pandemicto date, between the months of November 2002 and July 2003,

with 8,096 known infected cases and 774 deaths (a case-fatality

rate of 9.6%) worldwide being listed in the World Health

Organization's (WHO) 21 April 2004 concluding report.

Within a matter of weeks in early 2003, SARS spread from the

Guangdong province ofChina to rapidly infect individuals in some

37 countries around the world.
http://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Respiratory_disease


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As of May 2006, the spread of SARS has been

fully contained thanks to the efforts of the WHO,with the last infected human case seen in June

2003 (disregarding a laboratory induced infection

case in 2004).However, SARS is not claimed to have been

eradicated (unlike smallpox), as it may still be

present in its natural host reservoirs (animalpopulations) and may potentially return into the

human population in the future.


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Influenza Viruses

Influenza, commonly referred to as the flu, is an

infectious disease caused by RNA viruses of the family

Orthomyxoviridae(the influenza viruses), that affects

birds and mammals.Types of Influenza virus:

Influenza virus A

Influenza virus B

Influenza virus CIsavirus

Thogotovirus


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Antigenic drift

Antigenic drift is due to mutation. Antibodies to the HA proteinare the most important in protection, although those to NA also

play a role. Both proteins undergo antigenic drift (i.e. accumulate

mutations) and accumulate changes such that an individual

immune to the original strain is not immune to the drifted one.

Antigenic drift results in sporadic outbreaks and limited

epidemics.

Antigenic shift

Antigenic shift is due to reassortment. In the case of influenza

A, antigenic shift periodically occurs. Apparently "new" HAand/or NA are found in the circulating viral strains. There is little

immunity (particularly if both proteins change, or if new HA is

present) and an epidemic/pandemic is seen.


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H1N1, which caused Spanish flu in 1918, and Swine flu in2009

H2N2, which caused Asian Flu in 1957

H3N2, which caused Hong Kong Flu in 1968

H5N1, a pandemic threat in the 2007

08 flu seasonH7N7, which has unusual zoonotic potential

H1N2, endemic in humans and pigs

H9N2

H7N2H7N3

H10N7
http://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/H1N1


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105


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Avian FluHuman influenza pandemics over the last 100 years havebeen caused by H1, H2,and H3 subtypes of influenza A

viruses.

More recently, avian influenza viruses havebeen found to directly infect humans from their avian

hosts.

The recent emergence, host expansion, and spread of a

highly pathogenic avian influenza (HPAI) H5N1subtype in Asia has heightened concerns globally, both in

regards to mortality ofHPAI H5N1 in humans and the

potential of a new pandemic


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Since the first H5N1 outbreak occurred in 1997, there

has been an increasing number ofHPAI H5N1 bird-to-

human transmissions leading to clinically severe and

fatal human infections.

Although millions of birds have become infected withthe virus since its discovery, 248 humans have died from

the H5N1 in twelve countries according to WHO data as

of January 2009.

Epidemiologists are afraid that the next time such a virusmutates, it could pass from human to human. If this

form of transmission occurs, another pandemic could

result.
http://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHO


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The clinical manifestations of avian influenza in humans have

ranged from mild conjunctivitis to severe pneumonia with

multiple organ failure (MOF)

The main presenting symptom is pneumonia with fever and an

influenza-like illness. Diarrhea was present in upto 70% of thecases.

Many cases had both thrombocytopenia and lymphopenia.

Chest radiographic findings included interstitial infiltrates, lobar

consolidation, and air bronchograms.

Sixty-eight percent of patients developed ARDS and MOF within

6 days of disease onset.

The average time of death from disease onset was 910 days.


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DiagnosisThe clinical diagnosis of avian influenza

infection in humans is difficult and relies

on the epidemiological link to endemicareas, contact with sick or dead poultry, or

contact with a confirmed case of avian

influenza.Polymerase Chain Reaction (PCR)

on clinical samples with primers specific for

the viral subtype.


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TreatmentAntiviral therapy, Supportive

care, and Adjunctive therapies


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Antiviral TherapyThe adamantanes (rimantadine and amantadine) Adamantanes bindto the M2 protein on the viral capsule, HPAI H5N1 isolated from

Southeast Asia carriedthe mutation in M2 that conferred resistance to

this group of antivirals

Neuraminidase inhibitors (oseltamivir and zanamivir) The timing oftreatment is paramount, as earlier therapy is directly related to

improved survival. The greatest level of protection was seen if the

neuraminidase inhibitors were started within 48 hours of infection,

and protection rapidly dropped after 60 hours.

For oseltamavir, therapy has been at75 mg twice daily, with 75 mgonce daily reserved for prophylaxis.

Zanamivir is available in a dry powder inhalation at 10 mg twice daily

for treatment and 10 mg daily for prophylaxis.


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Vaccination

Not yet available


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Infection Control and

Preventative MeasuresWorld Health Organization (WHO) and Centers for Disease Control

and Prevention (CDC) recommend contact and airborne

precautions for any initial suspected case of avian influenza in ahuman.


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-Use ofmasks and respirators in the health care setting

In certain high risk procedures,additional protection with

an N-95 particulate respirator may be considered .

-Impermeable gown, face shield, and gloves.

-Initial cases should be placed in a negative pressure

isolation room with 6-12 air changes per hour.

-Hand hygiene with antibacterial soap or alcoholbased

washless gel should be standard, with appropriate basins

at each patient room.


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Infection control measures are the mainstay for

prevention and disease reduction. Avian influenza

viruses may constitute part of the

next pandemic, so appropriate knowledge,

prevention, and treatment will reduce the

likelihood of this occurrence.


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Thank you

Hanan Ibrahim Fatal Flu

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