Clinical signs and symptoms of Influenza

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Clinical signs and symptoms of Influenza
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Uncomplicated influenza symptoms

• Fever
• Myalgia
• Headache
• Malaise
• Nonproductive cough
• Sore throat,
• Rhinitis

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Additional Uncomplicated influenza symptoms more
common in children

• Otitis media
• Nausea
• Vomiting

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Uncomplicated influenza

• Illness typically resolves after 3--7 days for
  the majority of persons, although cough and
  malaise can persist for gt2 weeks.

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Complications of Influenza infection

• primary influenza viral pneumonia
• Exacerbation of underlying medical conditions
  (e.g., pulmonary or cardiac disease)
• secondary bacterial pneumonia, sinusitis, or
  otitis media
• coinfections with other viral or bacterial
  pathogens.

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Complicating factors in Young children

• initial symptoms mimicking bacterial sepsis with
  high fevers
• febrile seizures have been reported in 6--20 of
  children hospitalized with influenza
• 4--11 of children hospitalized with
  laboratory-confirmed influenza required treatment
  in the intensive care unit with3 required
  mechanical ventilation.
• Among 1,308 hospitalized children in one study,
  80 were aged lt5 years, and 27 were aged lt6
  months.
• uncommonly associated with encephalopathy,
  transverse myelitis, myositis, myocarditis,
  pericarditis, and Reye syndrome.

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• Respiratory illnesses caused by influenza virus
  infection are difficult to distinguish from
  illnesses caused by other respiratory pathogens
  on the basis of signs and symptoms alone.
• Sensitivity and predictive value of clinical
  definitions vary, depending on the prevalence of
  other respiratory pathogens and the level of
  influenza activity.
• Among generally healthy older adolescents and
  adults living in areas with confirmed influenza
  virus circulation, estimates of the positive
  predictive value of a simple clinical definition
  of influenza (acute onset of cough and fever) for
  laboratory-confirmed influenza infection have
  varied (range 79--88).

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Severe complications

• Influenza pneumonia
• Adult Respiratory Distress Syndrome
• Leukopenia (risk factor for secondary infection)
• Secondary bacterial infections
• Renal or multiorgan failure

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• Young children are less likely to have the usual
  influenza signs and symptoms, such as fever and
  cough.
• Infants may present with fever and lethargy, and
  may not have cough or other respiratory symptoms.
  Symptoms of severe disease in infants and young
  children may include apnea, tachypnea, dyspnea,
  cyanosis, dehydration, altered mental status, and
  extreme irritability.

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Treatment

• Who should be treated?
• All hospitalized patients
• Childrenlt5
• Pregnant women
• Asthma, COPD
• gt65
• Co morbid risk factors

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Treatment

• Neuramidase Antivirals appear to be effective
  with H1N1
• Start as early as possible in high risk
  individuals
• If question of oseltamivir resistance, use
  zanamivir unless ashtma or copd
• then use osetamivir plus amantidine or
  rimantidine

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Treatment

• If late pneumonia complications or asplenic
  individual cover for bacterial pneumonias