Recommended
More Related Content
What's hot
What's hot (20)
Similar to H1N1 Virus
Similar to H1N1 Virus (20)
Recently uploaded
Recently uploaded (20)
H1N1 Virus
- 1. Clinical seminar 30 of Nov
- 2. CASE STUDY A 30 years old Saudi female patient came to the ER on 19th of Nov complaining of fever and productive cough started at the same time one weak ago. The fever was documented through oral rout , it’s intermittent also it’s decrease by taking antipyretic but not resolved , no rigors and shivering. According to her cough it was productive with white sputum and cough associated with wheezing and SOB Shatha Haroun G:4
- 3. • Constitutional symptoms : no Constitutional symptoms • Systemic review : unremarkable • Past medical history : no chronic disease except bronchial asthma since born, not on inhaler with no history of exacerbation MEDICAL HISTORY • Past surgical history : unremarkable • Family history : no similar condition • Social history : married , teacher . non smoker and no recent traveling
- 4. PHYSICAL EXAMINATION • General examination : - Temp = 38.4 C - BP = 135/80 mm Hg - HR = 92 bpm • Mental status : conscious • CVS examination: normal • Chest examination : on auscultation bilateral wheezing , RR : 24 (high) Haneen Al-masudi G:5 • Abdomen examination : soft – lax – no tenderness • Genitalia / pelvic examination : normal • Bones & joints : normal • Nervous systems : intact
- 5. - H1N1 (swine flu ) - MERS co - Pneumonia Differential diagnosis
- 6. INVESTIGATION Lab investigation - CBC - Chemistry - Arterial blood gases - Chest x-ray - Swap for H1N1 & MERS Malak Alfaifi / Razan soleimani G:5
- 7. Reference rangeFlagsUnitResultTest 4 – 11NX10^3/uL7.29WBC 3.8 – 4.8HighX10^6/uL4.86RBC 12 – 15Ng/dL13.5HGB 38 – 48N%38.2HCT 83 – 101lowfL78.6MCV 27 – 32Npg27.8MCH 31.5 – 34.5Highg/dL36.3MCHC 150 – 400NX10^9/L200PLATLAT COUNT 11.6 – 14High%14.3RDW Malak Alfaifi G:5
- 8. Sysmex
- 9. Reference rangeFlagsUnitResultTest 40 – 80NX10^3/uL76.6NEUT% 20 – 40LowX10^6/uL16.9LYMP% 2 – 10Ng/dL6.3MONO% 1 – 6Low%0.1ESO% 0.02 – 0.1NfL0.1BASO% 2 – 7.5N10^3/UL5.58NEUT Count 1 – 3.5N10^3/UL1.23LYMP Count 0.2 – 0.9N10^3/UL0.46MONO Count 0.02 – 0.5Low10^3/UL0.01ESO Count 0.02 – 0.1Low10^3/UL0.01BASO Count Automated DIFF
- 10. Reference rangeFlagsUnitResultTest 34 – 50Ng/L36ALBUMIN 46 – 116NU/L57ALKALINE PHOSPHATASE 14 – 59NU/L32ALTI 25 – 115NU/L66AMYLASE 15 – 37HighU/L41AST (GOT) 2.1 – 2.5Lowmmol/l1.9CALCIUM 26 – 192HighIU/L671CKI 74 – 106Highmg/dl171GLUCOSE RANDOM 3.5 – 5.1Lowmmol/l3.2POTASSIUM 136 – 145Lowmmol/l131SODIUM 7 – 18Nmg/dl9BUN 0.6 – 1.3Nmg/dl0.7CREATININE
- 12. Blood Gas Values Reference rangeUnitResultTest 7.350 – 7.4507.504pH 35.0 – 45.0mmHg16.3Pco2 83.0 – 108mmHg126Po2 95.0 – 99.0%86.8sO2
- 14. After 2 day CRP and ESR tests performed and result show elevation in both of ESR and C-reactive protein (CRP) are both markers of inflammation . Reference rangeFlagsUnitResultTest 0-10Highmg/dL24CRP < 20Highmm/hr95ESR
- 15. Razan soleimani G:5 Respiratory specimens Oropharyngyal swab Nasopharyngeal swab
- 16. Lab Diagnosis Viral Culture Serology Real time RT PCR
- 17. Viral Culture Cell line Embryonated egg MDCK
- 18. Viral Culture "gold standard" for diagnosing influenza , but it can take up to 3-10 days for results. A faster culture method, known as shell vial culture, may detect the presence of a respiratory virus in 24-48 hours.
- 19. Serology HAI
- 20. Real time RT-PCR Real time RT PCR is a major development of PCR technology that enables reliable detection and measurement of products generated during each cycle of PCR process. Thermal cycler for PCR The most sensitive for influenza virus.
- 21. The result of our patient is +ve for H1N1
- 22. Chest X-ray
- 23. DIAGNOSIS C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection So, regarding to the previous history with signs & symptoms of : • Fever for 7 days • SOB • Productive cough ( Also our patient had Asthma ) All these factors lead us to suspect that our patient have H1N1 To confirm that we did RT-PCR and it showed +ve result Afnan Al-Yamani G:5
- 24. WHAT IS H1N1 VIRUS ? It’s a single stranded ( RNA ) that belong to the orthomyxoviridae family, It’s is roughly spherical, enveloped virus that is the outer layer is a lipid membrane which is taken from the host cell in which the virus multiplies. The virus is contagious and usually affects the respiratory tract endothelium , it can spread from human to human, Mainly by inhalation or ingestion of droplets from people sneezing or coughing also touching contaminated areas then touch your mouth or nose. Symptoms of swine flu in people are similar to the symptoms of regular human flu.
- 25. TREATMENT Antibiotic -Ceftraxone (Rocephin) (Klacid)-Clarithromycin Antiviral -Oseltamivir (Tamiful) Atheer Al-zubedi G:5
- 26. Bronchodilator -Albuterol (Ventolin) - O2 5L (face mask)… - lpatropium bromide (Atrovent)
- 28. HOW TO PROTECT YOURSELF AND OTHERS ? Afnan Al-yamani G:5
- 29. THANK YOU
- 30. Shatha haroun Haneen al-masodi Malak al-faifi Razan slimany Afnan al-yamani Atheer al-zubedi
Editor's Notes
- Asthma risk factor of H1N1
- Slightly that mean are normal A high RBC count may occur because: Red blood cell production increases to compensate for low oxygen levels due to poor heart or lung function Red blood cell production increases to compensate for lower oxygen levels at higher altitudes The kidneys release too much of a protein (erythropoietin, or EPO) that enhances red blood cell production The bone marrow is producing too many red blood cells The oxygen-carrying capacity of red blood cells is reduced The loss of blood plasma (the liquid component of blood), often due to sodium and water depletion, results in the appearance of higher levels of red blood cells Specific causes of high red blood cell count may include: Anabolic steroids, which stimulate red blood cell production Carbon monoxide poisoning Congenital heart disease in adults COPD Dehydration EPO doping (injections of erythropoietin (EPO) to enhance athletic performance) Heart failure Hemoglobinopathies (conditions present at birth that impair the oxygen-carrying capacity of red blood cells) Kidney cancer Kidney transplant Living at a high altitude, where there's less oxygen in the air Other types of heart disease Other types of lung disease Polycythemia vera Pulmonary fibrosis Sleep apnea Smoking, which may result in low blood oxygen levels --------------------------------------------------------------
- Known as lymphocytopenia : Infections (e.g., HIV, viral hepatitis, typhoid fever, influenza) Numbers are normally low in the blood. One or an occasional low number is usually not medically significant
- while the values of ALT and AST increased in 11 cases (5.3%); LD increased in 13 cases (6.3%); CR decreased in 11 cases (5.3%) and increased in 3 cases (1.4%); UN decreased in 13 cases (6.3%); K+ decreased in 28 cases (13.5%); Na+ decreased in 34 cases (16.3%) and increased in 5 cases (2.4%); and Cl- decreased in 44 cases (21.1%) and increased in 1 case (0.5%). Compared with the group of mildly ill patients, severely ill patients showed a larger abnormal ratio and amplitude (P<0.05).. In pediatrics by far the most common cause of elevated CPK is a viral infection that causes muscle inflammation ----------------------------------------- Despite the multi-systemic effects of influenza A/H1N1 virus, the occurrence of hepatic injury during the natural course of the infection remains a matter of debate. influenza A/H1N1 has also proven to have a negative impact concerning the function of other vital organs, such as the liver, kidneys, myocardium, gastrointestinal tract and central nervous system Despite their differences, all three studies indicate that liver injury was a more or at least equally frequent finding in H1N1-positive patients, as was the extent of the liver malfunction. Another common characteristic was the transient character of the liver injury, which was consistent with the severity of the infection and resolved at the stage of remission. Specifically, Papic et al [10], comparing the laboratory results between their two subgroups, they reported that liver enzymes were significantly elevated in the pandemic group (AST: 35.78% versus 18.60%, ALT: 26.31% versus 7.36%, GGT: 36. 84% versus 16.47%)
- pH is elevated (more alkaline, higher pH) with: Hyperventilation Anxiety, pain Anemia Shock Some degrees of pulmonary disease Some degrees of congestive heart failure Myocardial infarction Hypokalemia (decreased potassium) Gastric suctioning or vomiting Antacid administration Aspirin intoxication --------------------------- Decreased pCO2 is caused by: Hyperventilation Hypoxia Anxiety Pregnancy Pulmonary embolism (This leads to hyperventilation, a more important consideration than the embolized/infarcted areas of the lung that do not function properly. In cases of massive pulmonary embolism, the infarcted or non-functioning areas of the lung assume greater significance and the pCO2 may increase.) ----------------------------------------------- ELEVATED PO2 LEVELS ARE ASSOCIATED WITH: Increased oxygen levels in the inhaled air Polycythemia --------------------------------------------- Oxygen Saturation will fall if: Inspired oxygen levels are diminished, such as at increased altitudes. Upper or middle airway obstruction exists (such as during an acute asthmatic attack)
- What is C-reactive protein (CRP)? C-reactive protein (CRP) is a blood test marker for inflammation in the body. CRP is produced in the liver and its level is measured by testing the blood. CRP is classified as an acute phase reactant, which means that its levels will rise in response to inflammation. Other common acute phase reactants include the erythrocyte sedimentation rate (ESR) and blood platelet count. What are the main causes of an elevated C-reactive protein (CRP)? In general, the main causes of increased CRP and other markers of inflammation are: burns, trauma, infections, inflammation, active inflammatory arthritis, and certain cancers. ----------------------------------------------------------------- The erythrocyte sedimentation rate (ESR or sed rate) is a relatively simple, inexpensive, non-specific test that has been used for many years to help detect inflammation associated with conditions such as infections, cancers, and autoimmune diseases. ESR is said to be a non-specific test because an elevated result often indicates the presence of inflammation but does not tell the health practitioner exactly where the inflammation is in the body or what is causing it. An ESR can be affected by other conditions besides inflammation. For this reason, the ESR is typically used in conjunction with other tests, such as C-reactive protein.
- Nasopharyngeal swab and oropharyngeal swab , should be collected as soon as possible after illness onset and using swabs with a synthetic tip e.g. Dacron and an aluminum or plastic shaft. The swab specimen collection vials should contain 1-3ml of viral transport medium (e.g. containing, protein stabilizer, antibiotics to discourage bacterial and fungal growth, and buffer solution). sputum specimens are also acceptable.
- has been considered the "gold standard" for diagnosing influenza, but it can take up to 3-10 days for results. It can be used for confirmation of a positive rapid test result, to check a negative test result, or when someone is suspected to have flu. In this test, the influenza virus is actually grown and further identified in the laboratory A faster culture method, known as shell vial culture, may detect the presence of a respiratory virus in 24-48 hours; however, a traditional viral culture performed in a large test tube may require several days before the virus can be detected. Growing the virus in culture is useful for documenting which strains of influenza are circulating in the community and which antiviral agents are effective in treating these viruses.
- Polymerase Chain Reaction It is a technique used to make multiple copies of a segment DNA of interest, generating a large amount of copies from a small initial simple. Real time RT-PCR and other molecular tests – molecular tests detect viral genetic material in respiratory samples like a nasal or throat swab and are the most sensitive for influenza virus. These tests may be ordered to diagnose influenza A infection, especially in those who are seriously ill (hospitalized),
- In my opinion, chest radiographs in patients with suspected H1N1 should only be obtained if there is a cough or sore throat. Other symptoms associated with H1N1 do not warrant a chest radiograph unless absolutely necessary. The aim of this study is to review the chest X-ray findings in patients with swine origin influenza A (H1N1) virus infection. In conclusion the most common abnormal findings in chest radiographs in patients with S-OIV infection are increased peribronchovascular markings and hyperinflation, followed by unilateral, or bilateral ground glass opacity and/or consolidation. Ground-glass opacification/opacity (GGO) is a descriptive term referring to a hazy area of increased attenuation in the lung with preserved bronchial and vascular markings. It is a non-specific sign with a wide aetiology including infection, chronic interstitial disease and acute alveolar disease.
- 1- because we are at beginning of Winter season which maybe a risk factor for some viruses such as Corona (MERSA) and H1N1 also Asthma associated with the swine flu, Our patient result in test shows that she had +ve H1N1 2 - H1N1 has been labeled as a culprit of respiratory infections and pulmonary complications. However, involvement of other organs has been overlooked. 4- RT-PCR (Reverse transcription polymerase chain reaction )