Influenza

INFLUENZA
DEFINITION
Influenza is an acute respiratory illness caused by infection with influenza viruses. The illness
affects the upper and/or lower respiratory tract and is often accompanied by systemic signs and
symptoms such as fever, headache, myalgia, and weakness. Outbreaks of illness of variable
extent and severity occur nearly every winter
ETIOLOGIC AGENT
Influenza viruses are members of the Orthomyxoviridae family.

Influenza A and B viruses constitute one genus, and influenza C viruses make up the other.
viral
RNA.
EPIDEMIOLOGY
Influenza outbreaks are recorded virtually every year, although their extent and severity vary
widely.
. Except for the past two decades, global epidemics or pandemics have occurred
approximately every 10 to 15 years since the 1918-1919 pandemic
The most extensive and severe outbreaks are caused by influenza A viruses
In part, this predominance is a result of the remarkable propensity of the H and N
antigens of influenza A virus to undergo periodic antigenic variation
Major antigenic variations are referred to as antigenic shifts,
Minor variations are called antigenic drifts
Influenza A epidemics begin abruptly, peak over a 2- to 3-week period, generally last for
2 to 3 months, and often subside almost as rapidly as they began.
Epidemics of influenza occur almost exclusively during the winter months
PATHOGENESIS
The initial event in influenza is infection of the respiratory epithelium with influenza virus
acquired from respiratory secretions of acutely infected individual
Transmission occurs via aerosols generated by coughs and sneezes, although hand-to-
hand contact, other personal contact, and even fomite transmission may take place
The incubation period of illness has ranged from 18 to 72 h
CLINICAL MANIFESTATIONS
Influenza illness is characterized by the abrupt onset of systemic symptoms, such as headache,
feverishness, chills, myalgia, or malaise, and accompanying respiratory tract signs, particularly
cough and sore throat.
However, the spectrum of clinical presentations is wide, ranging from a mild, afebrile
respiratory illness similar to the common cold to severe prostration with relatively few
respiratory signs and symptoms.
In most of the cases that come to a physician's attention, the patient has a fever, with
temperatures of 38 to 41C (100.4 to 105.8F).
A rapid temperature rise within the first 24 h of illness is generally followed by a gradual
defervescence over a 2- to 3-day period, although, on occasion, fever may last for as long as a
week
Headache, either generalized or frontal, is often particularly troublesome.
Myalgias may involve any part of the body but are most common in the legs and
lumbosacral area.
Arthralgias may also develop.
Respiratory complaints often become more prominent as systemic symptoms subside.

Sore throat, persistent cough,
Ocular signs and symptoms include pain on motion of the eyes, photophobia, and burning of the
eyes
Physical findings are usually minimal in cases of uncomplicated influenza

The patient appears flushed and the skin is hot and dry
Examination of the pharynx may yield surprisingly unremarkable results despite a severe
sore throat, but injection of the mucous membranes and postnasal discharge are apparent
in some cases.
Mild cervical lymphadenopathy may be noted
Chest examination is largely negative in uncomplicated influenza, although rhonchi,

wheezes, and scattered rales have been reported
the acute illness generally resolves over a 2- to 5-day period,
COMPLICATIONS
"primary" influenza viral

The most common complication of influenza is pneumonia ---
pneumonia, secondary bacterial pneumonia, or mixed viral and bacterial pneumonia.
The most common pneumonic complications during outbreaks of influenza have mixed
features of viral and bacterial pneumonia.
Worsening of chronic obstructive pulmonary disease and exacerbation of chronic bronchitis and
asthma.
Reye's syndrome, a serious complication in children that is associated with influenza B

and to a lesser extent with influenza A virus infection as well as with varicella-zoster
virus infection.
Myositis, rhabdomyolysis, and myoglobinuria are occasional complications of influenza

infection
Myocarditis and pericarditis
encephalitis, transverse myelitis, and Guillain-Barre syndrome

Toxic shock syndrome caused by S. aureus
Influenza outbreaks include a number of cases in which elderly and other high-risk individuals
develop influenza and subsequently experience a gradual deterioration of underlying
cardiovascular, pulmonary, or renal functionchanges that occasionally are irreversible and lead
to death. These fatalities contribute to the overall excess mortality associated with influenza A
outbreaks
LABORATORY FINDINGS AND DIAGNOSIS
Laboratory diagnosis is accomplished during acute influenza by isolation of the virus from throat
swabs, nasopharyngeal washes, or sputum.
Other laboratory tests are generally not helpful in making a specific diagnosis of
influenza virus infection.
Leukocyte counts are variable, frequently being low early in illness and normal or
slightly elevated
DIFFERENTIAL DIAGNOSIS
Mycoplasma pneumonia
. Severe streptococcal pharyngitis or early bacterial pneumonia
TREATMENT
In uncomplicated cases of influenza, symptom-based therapy with acetaminophen for the relief of
headache, myalgia, and fever may be considered, but the use of salicylates should be avoided in
children below 18 years of age because of the possible association of salicylates with Reye's
syndrome
Patients should be advised to rest and maintain hydration during acute illness and should
return to full activity only gradually after the illness has resolved
Specific antiviral therapy is available for influenza:
amantadine and rimantadine for influenza A
zanamivir and oseltamivir for both influenza A and influenza B.
Antibacterial drugs should be reserved for the therapy of bacterial complications of acute
influenza, such as secondary bacterial pneumonia
PROPHYLAXIS
The major public health measure for prevention of influenza has been the use of inactivated
influenza vaccines derived from influenza A and B viruses that circulated during the previous
influenza season

Influenza

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INFLUENZA

Influenza viruses are members of the Orthomyxoviridae family.

The incubation period of illness has ranged from 18 to 72 h

Respiratory complaints often become more prominent as systemic symptoms subside.

Physical findings are usually minimal in cases of uncomplicated influenza

Chest examination is largely negative in uncomplicated influenza, although rhonchi,

"primary" influenza viral

Reye's syndrome, a serious complication in children that is associated with influenza B

Myositis, rhabdomyolysis, and myoglobinuria are occasional complications of influenza

encephalitis, transverse myelitis, and Guillain-Barre syndrome

LABORATORY FINDINGS AND DIAGNOSIS

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