This document provides guidance on clinical case management of influenza patients presenting with influenza-like illness (ILI) or severe acute respiratory illness (SARI). It outlines case definitions and describes potential case scenarios ranging from mild uncomplicated ILI to severe or complicated ILI. For mild cases, it recommends symptomatic care and antivirals for high-risk groups. Severe or complicated cases should be hospitalized, treated with antivirals, and may require intensive care. Clinical signs for hospitalization include respiratory distress, hypoxia, hypotension, or altered mental status.
Seasonal influenza is an acute respiratory illness caused by influenza viruses that typically occurs during winter. Common signs include fever, cough, sore throat, and muscle aches. While influenza is usually self-limiting, it can lead to serious complications like pneumonia, especially in high-risk groups. Pneumonia is the most common complication and can be either viral or secondary bacterial infections with pathogens like streptococcus pneumoniae or staphylococcus aureus. Influenza may also cause other rare complications affecting the heart, brain or muscles.
Clinical case Management Of Severe Acute Respiratory Infection SARIAshraf ElAdawy
This document provides guidance on clinical case management of severe acute respiratory infection (SARI). It defines SARI and outlines the typical clinical presentation. It discusses the principal etiological agents that can cause SARI, including various viruses and bacteria. The document provides guidance on initial patient assessment, diagnostic testing, exposure history, treatment including antivirals and antibiotics, supportive care, oxygen therapy and mechanical ventilation. The goal is to aid clinicians in managing SARI patients and detecting novel respiratory pathogens.
Influenza is an acute respiratory disease caused by influenza viruses types A, B, and C. It is characterized by fever, headache, cough, and body aches. It spreads through airborne droplets or contact with contaminated surfaces. Influenza affects people of all ages but has higher mortality rates in young children, elderly adults, and those with pre-existing medical conditions. While most cases are mild, influenza can lead to pneumonia as a complication. Prevention methods include vaccination, good hygiene practices, and isolating infected individuals.
This document provides information about the 2016/2017 inactivated influenza vaccine for Kuwait. It discusses the types and characteristics of influenza viruses, how the viruses can change through antigenic drift and shift, how the vaccine is made to match circulating strains, and recommendations for its composition and use to protect against seasonal influenza.
- Influenza viruses are divided into types A, B, and C. Type A is further divided into subtypes based on the H and N surface proteins, with 16 H and 9 N combinations possible.
- Wild birds are the natural reservoir for all influenza A subtypes. Antigenic drift causes small changes in circulating strains over time, necessitating annual vaccine updates. Antigenic shift involves genetic reassortment between human and animal viruses and can cause pandemics.
- Seasonal influenza causes annual epidemics that typically infect 10-20% of the population. While most recover without treatment, influenza can cause severe illness or death in high-risk groups. Avian influenza viruses usually do not
Infectious disease epidemiology describes influenza as an acute viral infection typically causing abrupt onset of fever and respiratory symptoms like cough and sore throat. Complications can include primary viral or secondary bacterial pneumonia. Influenza viruses are transmitted through respiratory secretions when people cough, sneeze or talk. There are annual epidemics in winter months in temperate regions that vary in severity each year. Pandemics occur less frequently and represent major antigenic shifts in influenza virus subtypes. Surveillance, vaccines, antiviral drugs, rest, and handwashing help prevent and treat influenza.
In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome. Two hundred years later, Wilson Smith and colleagues would isolate an influenza A virus, one of the members of the orthomyxovirus family. Swine influenza virus (SIV) or S-OIV (swine-origin influenza virus) is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3. Swine influenza (also called Pig influenza, swine flu, hog flu and pig flu) is an infection by any one of several types of swine influenza virus. In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths. Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy. Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed. This article presents the scenario of the 2009 H1N1 influenza, popularly known as “swine flu” and the data from inpatient admissions in Indraprastha Apollo Hospitals, Delhi, for the duration October 2009 to January 2010.
This document discusses influenza in children. Key points include:
- Influenza infection disproportionately affects young children and is a significant global disease burden, especially in developing countries.
- Children under 5 years old, especially under 2, are at highest risk of complications from influenza. Other high-risk groups include those with neurological disorders, heart or lung disease, diabetes, or immunosuppression.
- Common complications in children include pneumonia, ear infections, and myositis. Testing and early treatment with oseltamivir is recommended for high-risk groups and others requiring antiviral treatment.
Seasonal influenza is an acute respiratory illness caused by influenza viruses that typically occurs during winter. Common signs include fever, cough, sore throat, and muscle aches. While influenza is usually self-limiting, it can lead to serious complications like pneumonia, especially in high-risk groups. Pneumonia is the most common complication and can be either viral or secondary bacterial infections with pathogens like streptococcus pneumoniae or staphylococcus aureus. Influenza may also cause other rare complications affecting the heart, brain or muscles.
Clinical case Management Of Severe Acute Respiratory Infection SARIAshraf ElAdawy
This document provides guidance on clinical case management of severe acute respiratory infection (SARI). It defines SARI and outlines the typical clinical presentation. It discusses the principal etiological agents that can cause SARI, including various viruses and bacteria. The document provides guidance on initial patient assessment, diagnostic testing, exposure history, treatment including antivirals and antibiotics, supportive care, oxygen therapy and mechanical ventilation. The goal is to aid clinicians in managing SARI patients and detecting novel respiratory pathogens.
Influenza is an acute respiratory disease caused by influenza viruses types A, B, and C. It is characterized by fever, headache, cough, and body aches. It spreads through airborne droplets or contact with contaminated surfaces. Influenza affects people of all ages but has higher mortality rates in young children, elderly adults, and those with pre-existing medical conditions. While most cases are mild, influenza can lead to pneumonia as a complication. Prevention methods include vaccination, good hygiene practices, and isolating infected individuals.
This document provides information about the 2016/2017 inactivated influenza vaccine for Kuwait. It discusses the types and characteristics of influenza viruses, how the viruses can change through antigenic drift and shift, how the vaccine is made to match circulating strains, and recommendations for its composition and use to protect against seasonal influenza.
- Influenza viruses are divided into types A, B, and C. Type A is further divided into subtypes based on the H and N surface proteins, with 16 H and 9 N combinations possible.
- Wild birds are the natural reservoir for all influenza A subtypes. Antigenic drift causes small changes in circulating strains over time, necessitating annual vaccine updates. Antigenic shift involves genetic reassortment between human and animal viruses and can cause pandemics.
- Seasonal influenza causes annual epidemics that typically infect 10-20% of the population. While most recover without treatment, influenza can cause severe illness or death in high-risk groups. Avian influenza viruses usually do not
Infectious disease epidemiology describes influenza as an acute viral infection typically causing abrupt onset of fever and respiratory symptoms like cough and sore throat. Complications can include primary viral or secondary bacterial pneumonia. Influenza viruses are transmitted through respiratory secretions when people cough, sneeze or talk. There are annual epidemics in winter months in temperate regions that vary in severity each year. Pandemics occur less frequently and represent major antigenic shifts in influenza virus subtypes. Surveillance, vaccines, antiviral drugs, rest, and handwashing help prevent and treat influenza.
In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome. Two hundred years later, Wilson Smith and colleagues would isolate an influenza A virus, one of the members of the orthomyxovirus family. Swine influenza virus (SIV) or S-OIV (swine-origin influenza virus) is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3. Swine influenza (also called Pig influenza, swine flu, hog flu and pig flu) is an infection by any one of several types of swine influenza virus. In all, 50 cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths. Of these six people, one was pregnant, one had leukemia, one had Hodgkin disease and two were known to be previously healthy. Despite these apparently low numbers of infections, the true rate of infection may be higher, since most cases only cause a very mild disease, and will probably never be reported or diagnosed. This article presents the scenario of the 2009 H1N1 influenza, popularly known as “swine flu” and the data from inpatient admissions in Indraprastha Apollo Hospitals, Delhi, for the duration October 2009 to January 2010.
This document discusses influenza in children. Key points include:
- Influenza infection disproportionately affects young children and is a significant global disease burden, especially in developing countries.
- Children under 5 years old, especially under 2, are at highest risk of complications from influenza. Other high-risk groups include those with neurological disorders, heart or lung disease, diabetes, or immunosuppression.
- Common complications in children include pneumonia, ear infections, and myositis. Testing and early treatment with oseltamivir is recommended for high-risk groups and others requiring antiviral treatment.
The document discusses seasonal influenza viruses and influenza vaccines. It provides details on:
- The types and subtypes of influenza viruses (A, B, C) and their surface proteins (hemagglutinin and neuraminidase).
- How influenza viruses mutate through antigenic drift, requiring annual vaccine formulation updates.
- The global surveillance process used to determine the influenza strains included in seasonal vaccines for each hemisphere.
- Populations recommended to receive seasonal influenza vaccines, including pregnant women, young children, elderly adults, and those with chronic medical conditions.
- Evidence that seasonal influenza vaccines are safe, provide moderate protection even in mismatched seasons, and help prevent severe outcomes.
Influenza is a highly contagious viral infection that causes fever, body aches, and respiratory symptoms. It spreads easily and can cause severe illness especially in young children, elderly adults, and those with weakened immune systems. The influenza virus is classified into types A, B, and C. Type A causes the most serious disease. Symptoms are diagnosed through viral testing of respiratory samples. Complications can include pneumonia, which is especially dangerous for high-risk groups. Treatment focuses on antiviral drugs that target the virus's neuraminidase or M2 proteins.
Flu, Influenza and homeopathy treatmentPranav Pandya
Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions are at high risk for serious flu complications.
Influenza is comonly referred to as flu is an infectious viral disease caused by RNA Virus of the family Ortho-Myxoviridae (the Influenza Virus), that affect bird and mammals.
Common symptoms are Chills, fever, sorethroat, muscle pain, severe headache, coughing, fatigue and general discomfort.
Although confused with other influenza like illnesses, especially the common cold, influenza is a more severe disease.
Influenza viruses are members of the Orthomyxoviridae family and contain segmented negative-sense RNA. There are four types of influenza viruses (A, B, C, and D), with types A and B causing seasonal flu epidemics in humans. Influenza A viruses are further classified into subtypes based on combinations of hemagglutinin and neuraminidase proteins. Influenza spreads easily through respiratory droplets when infected people cough or sneeze. Symptoms include fever, cough, and sore throat. While most people recover within a week, influenza can cause severe illness or death in high risk groups. Laboratory tests can confirm the presence of the virus. Treatment focuses on relieving symptoms and antiviral
Influenza in Children Recommendations for Prevention &Treatment Ashraf ElAdawy
1. Seasonal influenza is caused by influenza viruses that mainly affect the respiratory system. While it can affect people of all ages, children, elderly, and immunocompromised individuals are most at risk of serious complications.
2. Influenza viruses are classified into types A, B, and C based on antigenic differences. Influenza A viruses are further subtyped by their surface proteins hemagglutinin and neuraminidase.
3. Influenza spreads through respiratory droplets from coughs and sneezes. Symptoms include fever, cough, sore throat, and body aches. While most people recover in a week, influenza can cause serious illness requiring hospitalization, especially in high-risk
This document provides information about influenza. It defines influenza as an infectious disease caused by RNA viruses of the orthomyxoviridae family that attacks the respiratory system. Seasonal influenza epidemics result in millions of cases, hundreds of thousands of hospitalizations, and tens of thousands of deaths in the US each year, making influenza a leading cause of death from vaccine-preventable illness. Transmission occurs via respiratory droplets from coughing or sneezing. Risk groups include young children, older adults, and those with weakened immune systems or chronic illnesses. Symptoms include fever, muscle aches, cough, and fatigue. Complications can include pneumonia. Treatment involves antiviral drugs like oseltamivir and zanamivir.
The document provides information about influenza (the flu). It describes influenza as a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. The flu can be spread through coughing, sneezing, or touching surfaces with the virus. Symptoms include fever, cough, sore throat, and tiredness. While similar to a cold, the flu causes more severe symptoms that can last for two to three weeks. Vaccination each year is recommended to prevent the flu.
This document summarizes several influenza pandemics throughout history. It discusses the epidemiology of influenza viruses and how they commonly mutate, requiring annual vaccines. It then describes several major flu pandemics in detail, including the deadly Spanish flu from 1918 which killed 20-50 million people globally, the Asian flu of 1957 caused by the H2N2 virus which killed 1-4 million, and the Hong Kong flu of 1968 caused by H3N2 virus which killed around 750,000 people worldwide including 34,000 in the US. It also briefly discusses the 1976 swine flu scare in the US.
The document summarizes key information about influenza virus. It belongs to the Orthomyxoviridae family and is a segmented, single-stranded RNA virus. It causes the highly contagious disease influenza, or flu. There are three main types - A, B, and C - with Type A being the most virulent and causing pandemics through antigenic drift and shift. Symptoms include fever, cough, and fatigue. Treatment involves antiviral drugs and vaccination, while prevention focuses on hand washing and avoiding contact with infected individuals.
Influenza types A and B are responsible for annual epidemics and can cause illness ranging from mild to severe or deadly. Each year, the WHO recommends updated influenza vaccine strains to protect against the viruses likely to circulate that season, based on global surveillance. Although the recommended strains remained the same from 2010-2012, annual vaccination is still recommended since immunity declines over time.
Influenza is a contagious respiratory illness caused by influenza viruses. Antigenic shift and drift lead to new viral strains and seasonal flu. Transmission occurs via droplets, direct contact, or surfaces. Vaccination and good hygiene are recommended for prevention. Antiviral drugs can reduce symptoms but are best taken within 48 hours of symptoms. High risk groups like young children, elderly, and pregnant women should get the flu shot annually.
Influenza is an acute respiratory infection caused by influenza viruses types A, B, and C. Type A is more pathogenic and causes pandemics by mutating into new subtypes. The virus attaches to respiratory cells using hemagglutinin and neuraminidase proteins. Symptoms include fever, cough, and sore throat. Complications can include pneumonia. Antiviral drugs like oseltamivir and zanamivir can reduce symptoms if taken early. Vaccination is recommended for high-risk groups annually.
What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact
This document discusses seasonal influenza and the 2009 H1N1 pandemic. It provides a timeline of 20th century influenza pandemics. It then discusses the 2015 swine flu epidemic in India, noting over 33,000 cases and 2,000 deaths reported. It also provides data on cases and deaths from swine flu at Dayanand Medical College & Hospital in Ludhiana, with 71 cases and 11 deaths. The document compares H1N1 to seasonal influenza and discusses epidemiology, virology and clinical presentation of influenza.
This presentation covers the epidemiology of influenza, including H1N1 influenza. It discusses the influenza virus types and subtypes, including antigenic shift and drift. It describes the 2009 H1N1 pandemic virus and the global, regional, and national epidemiological burden. Host and environmental epidemiological determinants are examined. The modes of transmission, clinical features, diagnosis, case management, prevention and control measures, and the national response are summarized.
Clinical Case Management of Outbreaks of Influenza-Like Ashraf ElAdawy
1. The document provides guidelines for the clinical case management of outbreaks of influenza-like illness (ILI), including definitions, assessment, and treatment recommendations.
2. It defines ILI and outlines criteria for classifying patients into mild, mild but high-risk, or severe ILI. Patients are assessed for symptoms, risk factors, and disease progression over 72 hours.
3. Treatment recommendations include symptomatic care for mild ILI, antivirals for mild ILI in high-risk groups, and antivirals in a hospital for severe ILI. Laboratory testing and hospital admission are based on illness severity and risk status.
Influenza is caused by influenza viruses that mutate frequently, sometimes resulting in global pandemics. The document discusses three pandemics from the 20th century caused by the H1N1, H2N2, and H3N2 strains. The deadly 1918 Spanish Flu pandemic may have killed over 50 million people. Influenza spreads through respiratory droplets and causes symptoms like fever, muscle aches, and cough. While similar to the common cold, influenza onset is usually more sudden. Antiviral drugs and vaccines can help prevent and treat influenza, but drug resistance is a growing problem due to the virus's frequent mutations.
This document discusses the pharmacological treatment of COPD, classifying medications by class. It describes long-acting bronchodilators including LAMAs which block acetylcholine-mediated bronchoconstriction and LABAs which directly relax airway smooth muscle. It also discusses fixed-dose combination LABA/LAMA inhalers, ICS/LABA inhalers, and the PDE-4 inhibitor Roflumilast which reduces inflammation but has no direct bronchodilator effect.
Management of Acute Exacerbztions of COPD at home Ashraf ElAdawy
An acute exacerbation of COPD is defined as a worsening of symptoms beyond normal day-to-day variations. Exacerbations can be caused by bacterial or viral infections and lead to increased symptoms, accelerated lung function decline, worse quality of life, and increased mortality. More than 80% of exacerbations can be managed at home with bronchodilators, corticosteroids, and antibiotics if purulent sputum is present. Treatment generally involves 5-10 days of antibiotics based on local resistance patterns and inhaled bronchodilators. Systemic corticosteroids for 5 days are as effective as 14 days for treating exacerbations. Prompt treatment of exacerbations is important to reduce the burden of COP
The document discusses seasonal influenza viruses and influenza vaccines. It provides details on:
- The types and subtypes of influenza viruses (A, B, C) and their surface proteins (hemagglutinin and neuraminidase).
- How influenza viruses mutate through antigenic drift, requiring annual vaccine formulation updates.
- The global surveillance process used to determine the influenza strains included in seasonal vaccines for each hemisphere.
- Populations recommended to receive seasonal influenza vaccines, including pregnant women, young children, elderly adults, and those with chronic medical conditions.
- Evidence that seasonal influenza vaccines are safe, provide moderate protection even in mismatched seasons, and help prevent severe outcomes.
Influenza is a highly contagious viral infection that causes fever, body aches, and respiratory symptoms. It spreads easily and can cause severe illness especially in young children, elderly adults, and those with weakened immune systems. The influenza virus is classified into types A, B, and C. Type A causes the most serious disease. Symptoms are diagnosed through viral testing of respiratory samples. Complications can include pneumonia, which is especially dangerous for high-risk groups. Treatment focuses on antiviral drugs that target the virus's neuraminidase or M2 proteins.
Flu, Influenza and homeopathy treatmentPranav Pandya
Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions are at high risk for serious flu complications.
Influenza is comonly referred to as flu is an infectious viral disease caused by RNA Virus of the family Ortho-Myxoviridae (the Influenza Virus), that affect bird and mammals.
Common symptoms are Chills, fever, sorethroat, muscle pain, severe headache, coughing, fatigue and general discomfort.
Although confused with other influenza like illnesses, especially the common cold, influenza is a more severe disease.
Influenza viruses are members of the Orthomyxoviridae family and contain segmented negative-sense RNA. There are four types of influenza viruses (A, B, C, and D), with types A and B causing seasonal flu epidemics in humans. Influenza A viruses are further classified into subtypes based on combinations of hemagglutinin and neuraminidase proteins. Influenza spreads easily through respiratory droplets when infected people cough or sneeze. Symptoms include fever, cough, and sore throat. While most people recover within a week, influenza can cause severe illness or death in high risk groups. Laboratory tests can confirm the presence of the virus. Treatment focuses on relieving symptoms and antiviral
Influenza in Children Recommendations for Prevention &Treatment Ashraf ElAdawy
1. Seasonal influenza is caused by influenza viruses that mainly affect the respiratory system. While it can affect people of all ages, children, elderly, and immunocompromised individuals are most at risk of serious complications.
2. Influenza viruses are classified into types A, B, and C based on antigenic differences. Influenza A viruses are further subtyped by their surface proteins hemagglutinin and neuraminidase.
3. Influenza spreads through respiratory droplets from coughs and sneezes. Symptoms include fever, cough, sore throat, and body aches. While most people recover in a week, influenza can cause serious illness requiring hospitalization, especially in high-risk
This document provides information about influenza. It defines influenza as an infectious disease caused by RNA viruses of the orthomyxoviridae family that attacks the respiratory system. Seasonal influenza epidemics result in millions of cases, hundreds of thousands of hospitalizations, and tens of thousands of deaths in the US each year, making influenza a leading cause of death from vaccine-preventable illness. Transmission occurs via respiratory droplets from coughing or sneezing. Risk groups include young children, older adults, and those with weakened immune systems or chronic illnesses. Symptoms include fever, muscle aches, cough, and fatigue. Complications can include pneumonia. Treatment involves antiviral drugs like oseltamivir and zanamivir.
The document provides information about influenza (the flu). It describes influenza as a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. The flu can be spread through coughing, sneezing, or touching surfaces with the virus. Symptoms include fever, cough, sore throat, and tiredness. While similar to a cold, the flu causes more severe symptoms that can last for two to three weeks. Vaccination each year is recommended to prevent the flu.
This document summarizes several influenza pandemics throughout history. It discusses the epidemiology of influenza viruses and how they commonly mutate, requiring annual vaccines. It then describes several major flu pandemics in detail, including the deadly Spanish flu from 1918 which killed 20-50 million people globally, the Asian flu of 1957 caused by the H2N2 virus which killed 1-4 million, and the Hong Kong flu of 1968 caused by H3N2 virus which killed around 750,000 people worldwide including 34,000 in the US. It also briefly discusses the 1976 swine flu scare in the US.
The document summarizes key information about influenza virus. It belongs to the Orthomyxoviridae family and is a segmented, single-stranded RNA virus. It causes the highly contagious disease influenza, or flu. There are three main types - A, B, and C - with Type A being the most virulent and causing pandemics through antigenic drift and shift. Symptoms include fever, cough, and fatigue. Treatment involves antiviral drugs and vaccination, while prevention focuses on hand washing and avoiding contact with infected individuals.
Influenza types A and B are responsible for annual epidemics and can cause illness ranging from mild to severe or deadly. Each year, the WHO recommends updated influenza vaccine strains to protect against the viruses likely to circulate that season, based on global surveillance. Although the recommended strains remained the same from 2010-2012, annual vaccination is still recommended since immunity declines over time.
Influenza is a contagious respiratory illness caused by influenza viruses. Antigenic shift and drift lead to new viral strains and seasonal flu. Transmission occurs via droplets, direct contact, or surfaces. Vaccination and good hygiene are recommended for prevention. Antiviral drugs can reduce symptoms but are best taken within 48 hours of symptoms. High risk groups like young children, elderly, and pregnant women should get the flu shot annually.
Influenza is an acute respiratory infection caused by influenza viruses types A, B, and C. Type A is more pathogenic and causes pandemics by mutating into new subtypes. The virus attaches to respiratory cells using hemagglutinin and neuraminidase proteins. Symptoms include fever, cough, and sore throat. Complications can include pneumonia. Antiviral drugs like oseltamivir and zanamivir can reduce symptoms if taken early. Vaccination is recommended for high-risk groups annually.
What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact
This document discusses seasonal influenza and the 2009 H1N1 pandemic. It provides a timeline of 20th century influenza pandemics. It then discusses the 2015 swine flu epidemic in India, noting over 33,000 cases and 2,000 deaths reported. It also provides data on cases and deaths from swine flu at Dayanand Medical College & Hospital in Ludhiana, with 71 cases and 11 deaths. The document compares H1N1 to seasonal influenza and discusses epidemiology, virology and clinical presentation of influenza.
This presentation covers the epidemiology of influenza, including H1N1 influenza. It discusses the influenza virus types and subtypes, including antigenic shift and drift. It describes the 2009 H1N1 pandemic virus and the global, regional, and national epidemiological burden. Host and environmental epidemiological determinants are examined. The modes of transmission, clinical features, diagnosis, case management, prevention and control measures, and the national response are summarized.
Clinical Case Management of Outbreaks of Influenza-Like Ashraf ElAdawy
1. The document provides guidelines for the clinical case management of outbreaks of influenza-like illness (ILI), including definitions, assessment, and treatment recommendations.
2. It defines ILI and outlines criteria for classifying patients into mild, mild but high-risk, or severe ILI. Patients are assessed for symptoms, risk factors, and disease progression over 72 hours.
3. Treatment recommendations include symptomatic care for mild ILI, antivirals for mild ILI in high-risk groups, and antivirals in a hospital for severe ILI. Laboratory testing and hospital admission are based on illness severity and risk status.
Influenza is caused by influenza viruses that mutate frequently, sometimes resulting in global pandemics. The document discusses three pandemics from the 20th century caused by the H1N1, H2N2, and H3N2 strains. The deadly 1918 Spanish Flu pandemic may have killed over 50 million people. Influenza spreads through respiratory droplets and causes symptoms like fever, muscle aches, and cough. While similar to the common cold, influenza onset is usually more sudden. Antiviral drugs and vaccines can help prevent and treat influenza, but drug resistance is a growing problem due to the virus's frequent mutations.
This document discusses the pharmacological treatment of COPD, classifying medications by class. It describes long-acting bronchodilators including LAMAs which block acetylcholine-mediated bronchoconstriction and LABAs which directly relax airway smooth muscle. It also discusses fixed-dose combination LABA/LAMA inhalers, ICS/LABA inhalers, and the PDE-4 inhibitor Roflumilast which reduces inflammation but has no direct bronchodilator effect.
Management of Acute Exacerbztions of COPD at home Ashraf ElAdawy
An acute exacerbation of COPD is defined as a worsening of symptoms beyond normal day-to-day variations. Exacerbations can be caused by bacterial or viral infections and lead to increased symptoms, accelerated lung function decline, worse quality of life, and increased mortality. More than 80% of exacerbations can be managed at home with bronchodilators, corticosteroids, and antibiotics if purulent sputum is present. Treatment generally involves 5-10 days of antibiotics based on local resistance patterns and inhaled bronchodilators. Systemic corticosteroids for 5 days are as effective as 14 days for treating exacerbations. Prompt treatment of exacerbations is important to reduce the burden of COP
Updates On Pharmacological Management Of Stable COPD 2017Ashraf ElAdawy
This document provides guidelines for the pharmacological management of stable COPD. It defines COPD as a preventable disease characterized by airflow limitation caused by exposure to particles or gases. The guidelines describe assessing patients based on symptoms, exacerbation history, and lung function (ABCD assessment). For Group A patients with low symptoms, treatment begins with a short- or long-acting bronchodilator. For Group B patients, treatment begins with a long-acting bronchodilator, escalating to a combination if needed. For Group C patients with exacerbations, treatment begins with a long-acting muscarinic antagonist (LAMA), adding a long-acting beta-agonist if exacerbations persist.
This document summarizes the key changes to COPD treatment guidelines between GOLD 2001, 2011, and 2017. It discusses the evolution from a unidimensional to multidimensional approach. The 2017 guidelines classify patients into groups A-D based solely on symptoms and exacerbation history. Treatment is tailored to the group, starting with bronchodilators and escalating to dual/triple therapy as needed. The guidelines emphasize LAMA/LABA combination therapy and provide guidance on adding or withdrawing ICS.
Asthma is a chronic inflammatory disease of the airways characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. It cannot be cured but can be well controlled through pharmacological treatment including inhaled corticosteroids and bronchodilators. Inhaled corticosteroids are the most effective long-term controller medication for asthma and help reduce exacerbations and mortality when used appropriately. Proper inhaler technique and regular monitoring of symptoms and lung function are important to achieve optimal asthma control.
The document provides information about seasonal influenza and inactivated influenza vaccines. It discusses what influenza is, how influenza viruses change over time through antigenic drift and shift, the composition and manufacturing of seasonal influenza vaccines, recommendations around who should receive the vaccine, and answers frequently asked questions about the vaccine. The document is written by Dr. Ashraf El-Adawy and provides a comprehensive overview of seasonal influenza vaccines.
Brief Counseling for tobacco use Cessation Ashraf ElAdawy
The document discusses smoking cessation interventions and counseling. It covers:
- Smoking cessation is one of the most cost-effective medical interventions.
- There are different levels of smoking cessation interventions from minimal to intensive counseling and treatment.
- The 5 A's model is presented as an effective brief intervention approach which includes Ask, Advise, Assess, Assist, and Arrange.
- Stages of change are discussed from precontemplation to maintenance to explain how readiness to quit smoking changes over time. Relapse is also part of the process for many smokers.
Tiotropium is a long-acting muscarinic antagonist (LAMA) that has been shown to improve asthma control when added to inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs) in adults with severe asthma. The document reviewed the pathophysiology of cholinergic bronchoconstriction in asthma and how tiotropium's M1/M3 receptor selectivity and long duration of action at these receptors provides 24-hour bronchodilation. Phase III clinical trials demonstrated that adding tiotropium to ICS/LABA resulted in improved symptom control, lung function, reduced severe exacerbations, and was well-tolerated with a safety profile comparable to
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
Updates On Pharmacological Management Of Asthma In AdultsAshraf ElAdawy
The document provides information on pharmacological management of asthma in adults. It defines asthma as a chronic inflammatory airway disease characterized by airway inflammation, obstruction, and hyperresponsiveness. The diagnosis is clinical based on symptoms such as wheezing and tightness. Asthma is caused by airway inflammation and management aims to control inflammation and symptoms. Treatment involves anti-inflammatory controllers such as inhaled corticosteroids and relievers for symptoms. A stepwise treatment approach is used starting with relievers and adding preventers as needed to gain control.
Sleep progresses through distinct stages in a cycle. Non-REM sleep begins with light sleep in stages 1 and 2, characterized by theta waves and sleep spindles. Stages 3 and 4 involve deep sleep with synchronized brain activity appearing as delta waves. REM sleep involves dreaming and similar brain activity to wakefulness. The circadian rhythm and homeostatic processes regulate sleep cycles, with the circadian rhythm promoting wakefulness opposed by the increasing homeostatic drive for sleep with time spent awake.
Updates On Pharmacological Management Of Pediatric AsthmaAshraf ElAdawy
This document provides information on the pharmacological management of pediatric asthma. It discusses asthma diagnosis and phenotypes in children, the goals of asthma treatment, and a stepwise approach to pharmacological management. Inhaled corticosteroids are recommended as the most effective long-term controller medication for asthma and should be considered as initial treatment for children using reliever medications frequently or experiencing frequent daytime symptoms. The starting dose of inhaled corticosteroids is 200 micrograms of beclomethasone dipropionate per day for children.
Can I use an asthma inhaler during Ramadan?Ashraf ElAdawy
Using an asthma inhaler during Ramadan is a complex issue with differing opinions among Islamic scholars. Some say it is permissible as the small amounts of liquid medicine do not reach the stomach. However, others say it breaks the fast as any substance entering the lungs could potentially reach the stomach. Muslims with asthma should consult medical experts on how to safely manage their condition during Ramadan to maintain their health and fast.
Rhinitis and asthma are linked diseases that often co-exist. They are both chronic inflammatory diseases of the airways that share common triggers and inflammatory pathways. Up to 80% of asthma patients have rhinitis and 40% of rhinitis patients have asthma. Rhinitis is a risk factor for developing asthma and is associated with worse asthma outcomes. Effective treatment of rhinitis can improve asthma control, reducing exacerbations and medication needs. Overall, rhinitis and asthma are considered linked manifestations of the same underlying airway disease process.
Diagnosis and treatment planning in conservative dentistry and endodonticsIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides guidelines for clinicians on the clinical management of patients with severe acute respiratory illness (SARI) when a novel coronavirus (nCoV) infection is suspected. It outlines recommendations for early recognition and triage of patients, immediate infection prevention and control measures, and early supportive care including oxygen therapy, conservative fluid management, empiric antimicrobials, and monitoring for clinical deterioration. The guidelines aim to optimize safe and effective management of critically ill patients and provide up-to-date interim guidance for healthcare workers.
The document provides guidelines for evaluating and managing patients with influenza-like illness (ILI) during pregnancy. It describes the symptoms of ILI and H1N1 flu. Patients with mild ILI symptoms and no risk factors can be treated as outpatients, while those with concerning signs, comorbidities, or symptom progression warrant further evaluation and treatment including Tamiflu and possible hospitalization.
This document provides guidance on the clinical management of individuals with influenza-like illness (ILI) during the H1N1 pandemic. It discusses ILI case definition, infectiousness and incubation period, clinical features of H1N1 infection in both adults and children, recognition of disease severity, and identifying those at high risk for complications. Individuals with ILI who are at high risk or have signs of moderate to severe illness based on clinical assessment tools should be considered for hospital admission and antiviral treatment. Close monitoring is needed to detect deterioration, as severe outcomes can result from primary viral pneumonia, secondary bacterial pneumonia, or destabilization of pre-existing medical conditions.
Pandemic influenza A (H1N1), also known as swine flu, is a respiratory disease caused by Type A influenza virus. It has caused both epidemics and pandemics. The virus spreads from person to person through coughing or sneezing or touching infected surfaces. High risk groups include young children, pregnant women, and those with chronic health conditions. Symptoms range from mild to severe and can include fever, cough, sore throat and vomiting. Treatment involves antiviral drugs, supportive care, and vaccination of high risk groups.
This document provides guidelines for the clinical management of COVID-19. It notes that while most cases are mild, approximately 14% of cases develop severe disease requiring hospitalization and oxygen support, and 5% require intensive care. Older age and comorbidities increase the risk of severe outcomes. For mild cases, isolation and symptomatic treatment is recommended, while severe cases may require oxygen therapy, fluid management, antimicrobials, and advanced support like mechanical ventilation for acute respiratory distress syndrome or vasopressors for septic shock. Testing for COVID-19 involves respiratory samples, and local protocols should be followed for patient isolation and discharge.
The document discusses the H1N1 influenza virus, including its epidemiology, clinical manifestations, diagnostic tests, treatment, and a study of H1N1 patients in Jordan. It finds that H1N1 posed a risk to young people and those with lung or pregnancy-related conditions. A study of 32 H1N1 patients in Jordan found most common symptoms were fever, cough and sore throat, and average hospitalization was 2.9 days with full recovery in 30 patients and death in 2 patients.
The document summarizes information about the 2009 H1N1 influenza pandemic. It describes how the virus was a new strain of influenza A virus containing genetic segments from swine, avian, and human influenza viruses. The pandemic prompted the WHO to declare a phase 6 pandemic in June 2009. The document provides details on case definitions, clinical features, treatment recommendations, infection control measures, and high-risk patient groups.
This document provides interim guidance for clinicians on managing patients with suspected or confirmed COVID-19. It outlines recommendations for screening, triage, infection prevention and control measures, specimen collection, and treatment of mild, severe, and critical COVID-19 cases. Key recommendations include screening all patients for COVID-19 at first contact, implementing droplet precautions like masks and patient isolation, and optimizing supportive care including oxygen therapy and monitoring for complications like ARDS, sepsis and septic shock. The guidance is meant to strengthen clinical management and provide best practices based on evidence from COVID-19 and other respiratory virus outbreaks.
A brief on Corona Virus, signs and symptoms and its management, virus, incubation period, medicines, treatment, mortality and severity with proper references.
Seasonal influenza is a highly contagious airborne disease that occurs annually, causing mild to severe illness and sometimes death. It is caused by influenza A and B viruses. Common symptoms include fever, cough, and fatigue. While most people recover within a week, those at high risk like the elderly and very young are more likely to develop severe complications. Vaccination is the most effective prevention strategy and is recommended annually for high risk groups.
Kuwait Influenza Case Management guidelines for 3nd Flu Workshop 2017Ashraf ElAdawy
This document provides guidelines for clinical case management of influenza-like illness (ILI) and severe acute respiratory illness (SARI) in Kuwait. It defines ILI and SARI case definitions and provides guidance on assessing and managing different levels of illness severity. For mild ILI, management at home is recommended, while those with high-risk conditions may require antiviral treatment. Severe ILI/SARI cases should be hospitalized and given early supportive therapy, antivirals, antibiotics if bacterial infection is suspected, and corticosteroids in some situations. Infection control procedures including standard, droplet and airborne precautions are also outlined.
1. COVID-19 is a respiratory illness caused by a novel coronavirus (SARS-CoV-2) that was declared a pandemic by the WHO in March 2020.
2. Symptoms range from mild to severe and include fever, cough, and shortness of breath. Chest imaging and PCR testing are used to diagnose the infection.
3. There is no specific treatment and care is supportive; prevention relies on hand hygiene, isolation of infected individuals, and social distancing measures.
How to Approach & manage COVID-19 Patient
Presented By
Dr. Ummay Sumaiya
ICU DOCTOR| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh
Mail: Ummay.Sumaiya@iqarus.com
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
This document provides an overview of the diagnosis and management of the 2019 novel coronavirus. It begins with background on coronaviruses in general and then focuses on the 2019-nCoV. It describes the clinical presentation of the infection, from uncomplicated illness to severe pneumonia, acute respiratory distress syndrome, and sepsis. It discusses diagnostic tests and recommendations for supportive care, oxygen therapy, fluid management, antimicrobial use, and monitoring for clinical deterioration. Guidelines are provided for management of hypoxemic respiratory failure, ARDS, septic shock, mechanical ventilation strategies, and ICU complications prevention. Currently no specific anti-coronavirus treatments exist but several clinical trials are underway to evaluate potential antiviral drugs.
Community acquired pneumonia [cap] in childrenHardik Shah
This document provides information on community acquired pneumonia (CAP) in children. It discusses the definition, epidemiology, etiology, pathogenesis, clinical presentation, risk factors, severity assessment, investigations, treatment and management of CAP in various pediatric age groups. Pneumonia is a leading cause of death in children under 5 years old worldwide. Clinical features may include cough, fever, difficulty breathing and vary depending on the child's age. Diagnosis is based on clinical signs and chest x-ray findings. Treatment involves hospitalization for severe cases and oral antibiotics for non-severe cases.
Covid Pathophysiology and clinical featuresNaveen Kumar
The document summarizes the pathophysiology of COVID-19. It discusses that SARS-CoV-2 enters cells through the ACE2 receptor and causes a cytokine storm. This can lead to organ damage and failure. Symptoms range from mild to severe and include fever, cough and shortness of breath. Those at highest risk are the elderly, immunocompromised, and those with pre-existing conditions like heart or lung disease. The clinical severity is classified as mild, moderate or severe based on symptoms and oxygen levels.
This document provides information about influenza (flu) including its definition, causes, symptoms, transmission, complications, diagnosis, treatment, and prevention. It defines influenza as a contagious respiratory illness caused by influenza viruses that can cause mild to severe symptoms. The document outlines that the flu spreads through droplets when infected people cough, sneeze or speak and can be inhaled or spread through contact with contaminated surfaces. It recommends getting an annual flu vaccine as the best way to prevent influenza and practicing good hygiene habits.
This revised guideline from the Government of India provides guidance on clinical management of COVID-19 patients. It outlines case definitions, clinical features, infection prevention and control measures, laboratory diagnosis, early supportive care including oxygen therapy and antimicrobials, and monitoring patients for deterioration. While corticosteroids are not routinely recommended, supportive care including conservative fluid resuscitation and timely management of sepsis or respiratory failure is emphasized.
This document provides guidelines for the management of community-acquired pneumonia and hospital-acquired pneumonia in adults. It defines key terms and outlines recommendations for diagnosis, severity assessment, antibiotic treatment, monitoring and discharge criteria for community-acquired pneumonia based on severity. For hospital-acquired pneumonia it recommends early antibiotic therapy chosen according to local guidelines, and durations of 5-10 days. Areas identified for further research include urine antigen testing to guide antibiotic treatment, C-reactive protein monitoring to reduce antibiotic duration, use of continuous positive pressure ventilation for respiratory failure, and rapid microbiological diagnosis to optimize antibiotic stewardship for hospital-acquired pneumonia.
Similar to Kuwait influenza case management guidelines for 2nd flu workshop 2016 (20)
How to get your taste and smell back after covid-19?Ashraf ElAdawy
- 30-80% of COVID patients experience loss of smell (anosmia) and taste, which usually recover within 1-4 weeks as the virus damages supporting cells in the nose rather than sensory neurons directly.
- For most, smell and taste return fully within 6 months but 5-10% experience long-term issues. Olfactory training over 12 weeks can help 30-50% of these patients and is recommended.
- The loss of smell is generally milder in patients with mild COVID cases versus moderate-severe cases and anosmia is often the first symptom, with smell usually returning as the infection clears.
This document discusses several topics related to influenza vaccination:
1. It explains that even healthy individuals who have avoided the flu in the past are still at risk each year and should get vaccinated, as flu strains evolve over time.
2. It describes the difference between trivalent and quadrivalent flu vaccines, with quadrivalent vaccines protecting against two influenza A strains and two B strains.
3. It notes that yearly flu vaccines are needed because immunity decreases over time and flu viruses can drift, requiring reformulation of the vaccine each season to match circulating strains.
Brain fog, insomnia, and stress: Coping after COVIDAshraf ElAdawy
Brain fog is difficulty thinking and concentrating that can worsen with fatigue. It's important to recognize these issues and manage them through pacing activities, minimizing distractions, and using memory aids and reminders. Relaxation techniques can help control anxiety from brain fog and conserve limited energy during recovery.
1. The document discusses fatigue experienced by some COVID patients, known as "Long COVID". It describes physical and mental fatigue and strategies to manage it.
2. It recommends activity pacing and graded exercise therapy. Activity pacing involves structuring activities with rest periods to avoid excessive mental or physical fatigue. Graded exercise therapy slowly increases the amount or intensity of exercise over time.
3. The strategies aim to help patients pace themselves and prioritize tasks based on their energy levels, taking rest breaks as needed to avoid running their "battery" flat and worsening their symptoms.
1. The document provides guidance for managing breathlessness after recovering from COVID-19, including breathing techniques and exercises to build strength gradually.
2. It recommends starting physical activity slowly and pacing oneself to avoid exacerbating breathlessness. Specific positions, breathing exercises, and home exercises are outlined.
3. Pacing activities by breaking them into smaller, achievable parts and alternating with rest is emphasized as an effective strategy for managing breathlessness and making steady progress.
Long COVID, also known as post-COVID syndrome, refers to symptoms that persist for weeks or months after the initial COVID-19 infection. It is estimated that 10-30% of COVID patients experience long COVID symptoms even if their initial infection was mild. Anyone who has had COVID, regardless of severity, can potentially develop long COVID. Symptoms may include fatigue, brain fog, muscle pain and other issues affecting multiple systems. The exact causes are unknown but may involve direct organ damage from the initial infection or an immune response. There are currently no treatments, only management of symptoms, and vaccination may help prevent long COVID by preventing initial COVID infection.
This document discusses the link between COVID-19 and tuberculosis (TB). It notes that COVID-19 disruptions have severely impacted TB treatment and care. It discusses whether TB increases risk for COVID-19 or vice versa, and notes that lung damage from TB may increase COVID-19 risk. The use of corticosteroids for COVID-19 could increase risk of reactivating latent TB infections. Screening for both diseases is recommended. Managing both diseases simultaneously may require continued TB treatment. Vaccines for both are generally safe and should not be delayed. Certain drug interactions between TB and COVID-19 treatments are also discussed.
COVID-19 : A look at possible future Scenarios? Ashraf ElAdawy
This document outlines 3 possible scenarios for the future course of the COVID-19 pandemic over the next 18-24 months according to medical experts: 1) alternating smaller peaks and valleys gradually diminishing over time, 2) a large second wave in fall/winter followed by smaller waves in 2021 similar to the 1918 flu, or 3) a "slow burn" of ongoing low-level transmission. The worst case scenario is a massive second wave exceeding the initial outbreak, overwhelming healthcare systems. Ongoing social distancing measures may be needed intermittently into 2022. Lifting lockdowns does not mean the end of COVID-19, which could remain for months or years until a vaccine is developed.
Asthma, COPD with COVID-19: What should HCPs need to know?Ashraf ElAdawy
People with asthma and lung conditions are at higher risk for severe illness from COVID-19. While asthma alone may not increase risk of contracting the virus, poorly controlled asthma can lead to worse outcomes. It is important for those with asthma to continue controller medications like inhaled corticosteroids and use oral steroids for exacerbations. Nebulizers should be avoided outside the home due to increased risk of transmission. Symptoms of asthma exacerbation can mimic COVID-19, but fever is more indicative of the virus. Face masks may be difficult for some with severe asthma but provide protection if able to be tolerated.
Novel coronavirus (COVID-2019) What we need to know?Ashraf ElAdawy
By February 11, 2020, there were over 44,000 confirmed cases of the 2019 novel coronavirus (2019-nCoV) globally, with the vast majority in China. Coronaviruses are a group of viruses that can infect humans and animals and cause respiratory illnesses. This particular strain was first identified in Wuhan, China in late 2019 and is believed to have originated in bats. Researchers recommend collecting respiratory samples like sputum, as well as serum samples, from suspected cases to test for the virus. As of February 15, 2020, over 1,400 people had died from the virus.
The document provides background information on coronaviruses and the 2019 novel coronavirus (2019-nCoV) outbreak that began in Wuhan, China in late 2019. It discusses coronaviruses in general, describing their structure and how some have evolved to infect humans. It then summarizes details about the initial 2019-nCoV outbreak cases linked to a seafood market, the virus's origins in bats and possible intermediate hosts, its spread between humans, and global responses to the outbreak.
The document discusses reasons for poor asthma control and strategies for improving inhaler technique and medication adherence. Some key points include:
- Poor asthma control can be due to incorrect diagnosis, improper inhaler technique, smoking, comorbid rhinitis, nonadherence to treatment, or inadequate treatment.
- Healthcare providers need proper training to effectively educate patients on correct inhaler use.
- Factors like particle size, inspiratory flow, and inhaler technique affect lung deposition and treatment effectiveness.
- Common inhaler devices include pressurized metered dose inhalers, dry powder inhalers, and soft mist inhalers. Proper priming, shaking, exhal
Asthma Medications in Clinical Practice - Part 2Ashraf ElAdawy
1. Montelukast (Singulair) is a leukotriene receptor antagonist used as a maintenance treatment for asthma. It comes in several formulations including chewable tablets and oral granules.
2. It should be taken once daily in the evening with or without food. Clinical trials show efficacy when taken in the evening, and morning dosing has not been evaluated.
3. The recommended pediatric dose is one 5mg chewable tablet daily for children aged 6-14. Higher doses have not been evaluated for safety in children and are not recommended.
1. The document outlines the GINA treatment steps for asthma management, which involve a stepwise approach to treatment based on asthma severity and control.
2. It begins with Step 1 involving use of a short-acting beta 2 agonist as needed and considers adding regular low-dose inhaled corticosteroids.
3. Steps then involve adding controllers as symptoms are not well controlled, such as low-dose inhaled corticosteroids and long-acting beta 2 agonists in Step 2, and medium-dose controllers in Steps 3 and 4. Step 5 involves referral to specialist care for add-on treatments.
Updates on pharmacological management of COPD 2020Ashraf ElAdawy
The document summarizes guidelines from the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report on the diagnosis and management of COPD. It outlines recommendations for initial pharmacological treatment based on a patient's classification into GOLD groups A-D. It also describes a new management cycle approach for follow-up treatment based on symptoms and exacerbations rather than GOLD group. Blood eosinophil counts are also introduced to help guide treatment choices, particularly the use of inhaled corticosteroids.
Asthma Medications in Clinical Practice - Part 1Ashraf ElAdawy
Asthma is a chronic inflammatory disease of the airways that cannot be cured but can be controlled. While medications are available to manage asthma, over half of patients still have poor control of their symptoms. Asthma deaths are preventable but still occur due to inappropriate management such as overreliance on reliever medications instead of preventer medications. The goal of asthma treatment is to control the disease through the stepwise use of controller medications such as inhaled corticosteroids in combination with reliever medications as needed. Proper inhaler technique and medication adherence are important for achieving optimal asthma control.
The document discusses metered-dose inhalers (pMDIs). It describes how pMDIs work by mixing active ingredients with propellants in a pressurized canister. When the actuator is pressed, a dose is released into the mouthpiece for inhalation. Key components include the canister, propellants, metering valve, and actuator. The document also covers priming pMDIs, proper inhaler technique, storage, advantages and limitations.
Pneumococcal vaccine in adults “Clinical Scenarios”Ashraf ElAdawy
This document provides information about Streptococcus pneumoniae (pneumococcus), including its transmission, colonization, clinical syndromes, risk groups, and vaccines for prevention. Some key points:
- Pneumococcus is a gram-positive bacterium commonly found in the respiratory tract. It has a polysaccharide capsule that helps it evade the immune system.
- Transmission occurs via respiratory droplets from carriers or those infected. Colonization often occurs without symptoms.
- It can cause pneumonia, bacteremia, and meningitis with varying case fatality rates. Those at highest risk are young children, older adults, and those with underlying conditions.
- The vaccines are PCV13
Pneumococcal vaccine in adults with CKD “Clinical Scenarios”Ashraf ElAdawy
The patient is a 50-year-old man with stage 5 chronic kidney disease who is interested in kidney replacement therapy options. His preference is preemptive kidney transplantation as he has a potential donor undergoing evaluation. If transplantation is not an option, he has decided on peritoneal dialysis. Given his symptoms and worsening kidney function, the doctor recommends starting kidney replacement therapy and referring him for peritoneal dialysis catheter insertion pending the donor's evaluation. The doctor should recommend pneumococcal and influenza vaccines given the patient's risk factors of chronic kidney disease and potential immunosuppression from transplantation or dialysis.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Kuwait influenza case management guidelines for 2nd flu workshop 2016
1. Clinical Case Management of
Influenza Patients with ILI & SARI
Dr. Ashraf El-Adawy
Consultant Chest Physician
TEAM Expert – WHO/EMRO
Kuwait 2nd
National Workshop on
Clinical Case Management of Influenza
Sate of Kuwait
Ministry of Health
Publ ic Healt h Depa rtment
Communicable Diseases Control Division
World Health Organization
2. Clinical Case Management of Influenza Patients with ILI & SARI 2016
2 WHO Expert Team Dr. Ashraf El-adawy
Kuwait 2nd
National Workshop on
Clinical Case Management of Influenza Patients with ILI & SARI
By
Dr. Ashraf El-Adawy
Consultant Chest Physcian
TEAM Expert – WHO
Public Health Department
Communicable Diseases Control Division
2016
3. Clinical Case Management of Influenza Patients with ILI & SARI 2016
3 WHO Expert Team Dr. Ashraf El-adawy
Clinical Case Management of Outbreaks of Influenza
Like-Illness & Severe Acute Respiratory Illness (SARI)
Case Definitions
Influenza-like-illness (ILI) case definition:
An acute respiratory infection with:
Measured fever of ≥ 38 C°
And cough;
With onset within the last 10 days.
Influenza infection causes a clinical syndrome not easily distinguished from other
respiratory infections.
Even though influenza can be caused by many different strains of influenza virus, the signs
and symptoms are similar for all types.
The range of symptoms observed with influenza virus infections is nonspecific and
resembles the clinical picture of a variety of other pathogens. There is no single symptom or
group of symptoms that is exclusive only to influenza.
In addition to the influenza viruses, other respiratory viruses can also cause ILI symptoms,
such as human respiratory syncytial virus , human parainfluenza viruses , rhinovirus,
adenovirus, human coronaviruses and human metapneumovirus .
Severe acute respiratory illness (SARI)
A person meeting the case definition of influenza‐like illness AND requiring hospital
admission.
SARI case definition
An acute respiratory infection with:
History of fever or measured fever of ≥ 38 C°;
And cough;
With onset within the last 10 days;
And requires hospitalization
Guide to assessment and management of ILI :
The clinical presentation of influenza can vary from asymptomatic infection to a serious
fatal illness that may include exacerbation of other underlying conditions and severe viral
pneumonia , ARDS, with multi‐organ failure.
The clinical management of influenza‐like illnesses will follow a protocolized step in both
the primary and secondary or tertiary level health care facilities.
The clinical assessment should ideally begin in the triage area whenever a patient is
suspected of ILI.
4. Clinical Case Management of Influenza Patients with ILI & SARI 2016
4 WHO Expert Team Dr. Ashraf El-adawy
The assessment will lead to screening out of patients for treatment, either in hospital or at
home ,from those without having any visible signs or symptoms of ILI requiring no
treatment.
However, on an individual patient basis, initial treatment decisions should be based on
clinical presentation and epidemiological data and should not be delayed pending
laboratory confirmation , a decision to treat will depend upon clinical judgment.
Case description: possible Case scenarios
1) Mild or Uncomplicated influenza-like illness (ILI)
Influenza-like illness symptoms: fever, cough, sore throat, rhinorrhea, headache, muscle
pain, malaise, without shortness of breath or dyspnoea.
Gastrointestinal illness such as diarrhoea and/or vomiting, especially in children, but
without evidence of dehydration.
The general condition of these patients will be good, (stable medical condition) without
any signs of hypotension or mental confusion.
2) Mild or Uncomplicated influenza-like illness (ILI) in high risk groups:
In Patients who meet ILI clinical case definition and in high risk group for serious or
life-threatening influenza complication (with stable medical condition) for example :
Complications of influenza
Influenza-associated pneumonia
Patients presenting only with mild influenza like illness and are not in a group known
to be at‐risk of developing severe or complicated illness, and without any clinical
signs of progression to severe illness can be treated at home with only symptomatic
treatment . These groups of patients need not be treated with antiviral medication.
G Pregnant women (up to two weeks post partum)
G age <2 years or ≥65 years
G Persons with the following underlying conditions at any age:
Chronic Broncho‐pulmonary disease (Including asthma & COPD& OSA )
Chronic cardiovascular diseases (Including CHF& MI , except hypertension)
Metabolic disorder (specially Diabetes mellitus)
Chronic liver or renal failure
Chronic neurologic disorder (Cerebral palsy, stroke, multiple sclerosis,
muscular dystrophy, seizure disorders etc)
Immune suppressed patients (HIV, immunosuppressive medications,
malignancy , long term steroids)
Haemoglobinopathies
Morbid obesity(i.e., body-mass index ≥40)
5. Clinical Case Management of Influenza Patients with ILI & SARI 2016
5 WHO Expert Team Dr. Ashraf El-adawy
Typical influenza disease does not occur in every infected person, In otherwise healthy
individuals, influenza infection normally results in an uncomplicated URTI that resolves
within 1–2 weeks.
Although many people think of influenza as just a common cold, it is really a specific and
serious respiratory infection that can result in hospitalization and death
Pneumonia is a relatively common complication (5–38% with influenza A and 10% with
influenza B), predominantly in the elderly, patients with chronic
cardiopulmonary disease, pregnant women and immunocompromised individuals.
The etiology may be viral, bacterial or mixed viral–bacterial. Such patients can deteriorate
rapidly and mortality can be close to 50%.
In primary viral pneumonia, typical influenza is followed by a rapid progression (over 2–3
days) of fever, cough, dyspnoea, chest pain and cyanosis. Physical examination
& chest X-ray disclose diffuse bilateral infiltrates consistent with acute respiratory distress
syndrome. If fatal, death usually occurs within 4–5 days of first symptoms.
Bacterial pneumonia as a complication of influenza also has a different presentation from
primary viral pneumonia, Patients initially show clinical improvement from illness and then
develop worsening respiratory symptoms. In this case, physical and chest X-ray
examinations are more likely to show localized signs of consolidation.
Combined viral–bacterial pneumonia is more common than primary viral pneumonia , Of
patients with a severe pneumonia, 75% will have secondary bacterial infection. In these
cases, the individual will appear to be recovering from the influenza illness and then have a
recurrence of the respiratory symptoms.
The bacteria most commonly involved are Staphylococcus aures and streptococcus
pneumoniae, with Haemophilus influenzae being less common.
There is evidence that influenza infection actively facilitates the pathogenicity of bacteria
and the impact of illness, causing immunosuppression.
Once the responsible pathogen has been identified, appropriate antibiotic treatment should
be initiated promptly.
Influenza B virus can cause the same spectrum of disease as that seen afte influenza A virus
infection, and severe illness can occur, particularly in the elderly.
Other respiratory complications
Exacerbations of asthma, chronic obstructive pulmonary disease and cystic fibrosis are
common complications of influenza illness.
Non-respiratory complications
Myositis is reported more frequently in children with influenza B, but adults may also be
affected and may develop rhabdomyolysis with acute renal failure.
Cardiac complications, specifically myocarditis, have been described in patients with
influenza A and B, but these complications are mostly asymptomatic. Pericarditis has been
reported rarely.
CNS complications are rare & range from irritability and confusion to psychosis and severe
encephalopathy due to a variety of inflammatory processes, including Reye's syndrome ,
Recovery is usually complete.
6. Clinical Case Management of Influenza Patients with ILI & SARI 2016
6 WHO Expert Team Dr. Ashraf El-adawy
Management of patients with Mild or Uncomplicated ILI at home
Prescribing oseltamivir
Oseltamivir is active against all currently circulating human influenza viruses.
Treatment should be started as soon as possible ,The usual dose is 75 mg taken orally twice
a day for adults and children >40 kg for 5 days , In smaller children use weight based dosing.
The principles of treatment at home for these categories of patients include the followings:
Applying home isolation and advising rest till the patient becomes afebrile.
Administering appropriate infection control measures at home.
Using analgesics or antipyretics, however Acetylsalicylic acid should be avoided specially in
children (The drug of choice should be Acetaminophen).
Aspirin‐containing products should not be administered to patients aged 18 years old and
younger due to the risk of Reye's syndrome.
For Mild or non-severe influenza-like illness (ILI) in high risk groups , treat with
antivirals (a neuraminidase inhibitor such as oseltamivir )at home, and close
home observation with instruction to return to care if they fail to improve in 72
hours or deteriorate,develop severe symptoms. If this occurs, hospitalization
should be considered.
Signs and symptoms of progressive disease or deterioration
Symptoms and signs suggesting cardiopulmonary insufficiency:
Shortness of breath, difficulty in breathing , bloody or colored sputum, hemoptysis ,
cyanosis, chest pain and hypotension.
In children fast or laboured breathing may indicate progressive disease.
Hypoxia as indicated by pulse oximetry.
Symptoms and signs suggesting central nervous system (CNS) complications:
Altered mental status, unconscious, drowsy, or difficult to awaken; recurring or
persistent convulsions (seizures), severe weakness or paralysis.
Evidence of sustained virus replication or invasive secondary bacterial infection:
Based on laboratory testing or clinical signs (e.g. persistent high fever and other symptoms
beyond three days, sepsis, rapid deterioration).
Severe dehydration:
Decreased activity, dizziness, decreased urine output, lethargy.
Children can also present with poor feeding, and excessive diarrhea and vomiting.
Persons with mild influenza like illness who present with an uncomplicated
febrile illness typically do not require antiviral treatment unless they are at
higher risk for serious influenza complications.
7. Clinical Case Management of Influenza Patients with ILI & SARI 2016
7 WHO Expert Team Dr. Ashraf El-adawy
Hydrating patients with abundant liquids in accordance with the need and patient’s
condition.
Following‐up clinical evolution of the patient by health care worker or by family members
checking for signs and symptoms of progression to severe illness & Recognize patients that
fail to improve within 72 hrs or deteriorate.
Home-care messages can be categorized as follows:
Regarding decision making algorithm for the patient presenting with Mild ,
uncomplicated influenza-like illness (ILI) , It takes into account the presence or
absence of risk factors for severe disease and on the progression & deterioration of
the disease over 72 hours.
All Patients who have mild uncomplicated ILI (whether with or without risk
factors) ,should be instructed to return for follow-up, when they develop any
signs or symptoms of progressive disease or fail to improve within 72 hours of
the onset of symptoms. If this occurs, hospitalization should be considered.
8. Clinical Case Management of Influenza Patients with ILI & SARI 2016
8 WHO Expert Team Dr. Ashraf El-adawy
3) Severe or Complicated influenza-like illness (ILI)
When influenza is known or suspected to be circulating widely in the community and the patient has
ARI symptoms, suspect severe influenza virus infection when there is rapid progression to severe
critical illness, including: Severe pneumonia, ARDS (acute respiratory distress syndrome) , and
severe sepsis, or any end-organ dysfunction (shock, encephalitis, myocarditis) or exacerbation of
chronic illness, co-infection with bacterial pneumonia or severe dehydration.
Mild or Uncomplicated influenza-like illness (ILI)
High Risk Groups
Symptomatic care at home
Instruction on infection
control
Return for care if no
improvement within 72 hours
Treat with antiviral at home
No influenza laboratory test
Instruction on infection
control
Return for care if no
improvement within 72 hours
Hospital admission
Treat with antiviral
Influenza laboratory
test.
When influenza viruses are known to be circulating in a community, patients
presenting with features of uncomplicated influenza( Mild ILI with or without
high risk factors of developing severe or complicated illness ) can be diagnosed on
clinical and epidemiological grounds, will not require influenza laboratory
confirmation.
Any deterioration or failure to improve within 72 hours
(Complicated OR progressive illness)
NO High Risk
9. Clinical Case Management of Influenza Patients with ILI & SARI 2016
9 WHO Expert Team Dr. Ashraf El-adawy
influenza virus infection in any patient can result in severe or complicated illness ,even in patients
who present initially with uncomplicated influenza.
In severe cases, patients generally begin to deteriorate around 3 to 5 days after symptom onset.
In some cases, especially if the cause is a primary viral pneumonia, deterioration may be rapid,
progressing to respiratory failure within 24 hours, requiring immediate admission to an intensive
care unit for respiratory support.
Note:
o Shortness of breath is not typical of uncomplicated influenza virus infection, and is suggestive
of severe disease.
o Respiratory rate is a very useful parameter in evaluating dyspnea or difficulty breathing .
Criteria for hospitalization (Signs of severe influenza like illness (ILI)
Or signs of rapid progression of illness, such as :
Presence of fever ≥ 38°C
Dyspnoea or difficult breathing
Cyanosis, bloody or colored sputum, chest pain
Hypoxia as indicated by pulse oximetry ( Oxygen saturation < 92% despite full
oxygen saturation)
Alteration of vital sign :
Arterial hypotension (Systolic blood pressure <90 mm Hg & diastolic blood pressure < 60 mm Hg)
Respiratory rate frequency increased (over 30 breaths per minute)
Cardiac frequency increased (Heart rate > 120bpm)
Altered level of consciousness: New confusion, striking agitation or seizures or depressed level of
consciousness
Severe Dehydration (Loss of more than 10 % of body weight as evidenced by
absent or low peripheral pulse, poor skin turgor, undetectable blood pressure
and sunken eyes)
Abnormal chest‐x ray (Chest x‐ray showing pulmonary infiltrates)
Patient that return for a second consultation with recurrent or persistent fever
( fever not subsiding beyond 3 days despite under treatment with analgesics)
10. Clinical Case Management of Influenza Patients with ILI & SARI 2016
10 WHO Expert Team Dr. Ashraf El-adawy
Upper limits of respiratory rate by age Increased respiratory rate (tachypnea)
< 2 months > 60 breaths/minute
2-11 months > 50 breaths/minute
12 months to 5 years > 40 breaths/minute
Adults > 26 breaths/minute
o Another parameter which can be used to evaluate difficulty breathing is oxygen saturation
while breathing ambient air. Measured by digital pulse oximetry, saturation should be 95% or
greater.
o Saturation < 90% is an indication of severe disease, while in pregnant women, <95% can
indicate severe disease.
Patients with complicated or severe ILI should be
hospitalized & treated with antiviral.
Criteria for admission in the Intensive Care Unit :
Consider ICU admission for patients with, or at risk of severe single or multi-organ
dysfunction ,as evidenced by the followings:
G Signs of progressive infiltrates on chest x‐ray
G Persistent hypoxia ( SpO2 < 92%) or
G respiratory exhaustion despite maximum oxygen saturation
G Progressive hypercapnoea
G Presence of compromised haemodynamics
G Signs of sepsis and imminent shock
Influenza can be diagnosed based on clinical presentation in the context of
known or suspected influenza activity in your community and should be
part of a broader differential diagnosis in patients with severe acute
respiratory illness (SARI).
11. Clinical Case Management of Influenza Patients with ILI & SARI 2016
11 WHO Expert Team Dr. Ashraf El-adawy
Differential diagnosis and diagnostic tests of severe ILI & SARI:
When influenza is suspected or known to be circulating in your community, for patients presenting
with signs and symptoms of severe pneumonia, include influenza virus infection on the differential
diagnosis, but also remember to include other pathogens that also present with severe pneumonia.
These include the following:
Community acquired pneumonia pathogens (e.g. Streptococcus pneumoniae,
Staphylococcus aureus, Hemophilus influenzae, Legionella pneumophila, Mycoplasma
pneumoniae ) .
Other respiratory viruses e.g. Respiratory Syncytial Virus (RSV), Parainfluenza, adenovirus,
human metapneumovirus, human coronavirus .
Fungal infections, in endemic areas for certain fungal infection
people living with HIV, consider Mycobacterium tuberculosis (TB), Pneumocystis
jirovecipneumonia (PjP or PCP) .
Examples of possible etiologic agents of unusual SARI
Severe acute respiratory illness (SARI) has been documented as a common feature of recent
emerging, novel respiratory pathogens e.g Avian influenza A (H7N9) , A (H5N1) and Middle
East Respiratory Syndrome Coronavirus (MERS-CoV).
All patients with signs and symptoms of possible SARI , presenting to the Emergency
Department or admitted to Hospital ,should be questioned about recent travel to, residence
in or contact with sources for SARI-related novel and emerging infections.
Clinicians should consider the patient clinical presentation & epidemiological links
(exposures) when investigating SARI.
Hospitalize patients with SARI suspected of severe influenza infection when there is
evidence of progressive, severe or complicated disease i.e. severe pneumonia, severe
sepsis, shock or any other organ dysfunction, or exacerbation of chronic medical
conditions.
Severe acute respiratory illness (SARI)
A person meeting the case definition of influenza‐like illness AND requiring hospital
admission,thise case definition is provided for use in the in-patient hospital settings.
The case definition for Severe Acute Respiratory Infection (SARI) is provided as a standard to
enumerate severe respiratory infections (including those caused by influenza) leading to
hospitalization.
The clinical manifestations Of SARI are not specific, Rather, they are shared by many different
infectious diseases.
12. Clinical Case Management of Influenza Patients with ILI & SARI 2016
12 WHO Expert Team Dr. Ashraf El-adawy
Exposure criteria : Clinicians should assess for epidemiological risk factors by obtaining an
exposure history including recent links to affected areas ( in countries where emerging
respiratory illnesses such as MERS-CoV1 or Avian influenza strains
such as H7N9, H5N1 have been reported) OR close contact with an ill person (with a
confirmed or probable case within the 10-14 days prior to symptom onset) .
13. Clinical Case Management of Influenza Patients with ILI & SARI 2016
13 WHO Expert Team Dr. Ashraf El-adawy
Diagnostic tests for severe ILI & SARI:
Respiratory tract specimens for influenza testing should be collected as soon as possible
after onset of illness in patients in whom treatment may be affected by making the
diagnosis, such as those with progressive or severe illness (severe ILI) .
Collect respiratory specimens for laboratory testing before antiviral therapy is initiated.
Upper respiratory tract specimens (nasopharyngeal and nasal specimens generally have
higher yields than throat swab specimens).
Nasopharyngeal swabs are the preferred swabs for respiratory virus testing. Nasal swabs
may be used if NP swabs are not available.
Reverse transcriptase polymerase chain reaction (RT-PCR ) are diagnostic tests of choice for
accurate and timely diagnosis of influenza virus infection.
RT-PCR tests can detect the presence of the virus ribonucleic acid or RNA (a fragment of the
virus) and they can identify the influenza virus (A,B) and subtypes both in upper and lower
respiratory tract specimens.
RT-PCR has both a high sensitivity (86%-100%) and high specificity and distinguishes
specific influenza virus from others.
The test requires a special laboratory and takes about 6-8 hours to perform in the laboratory
but delays may occur during transport to laboratory and laboratory batching.
Specimen collection should be always performed with appropriate infection prevention
precautions.
Rapid influenza diagnostic tests (Point-of-care test) can produce quick results in 15 minutes
or less, however false negative results are common
Rapid Influenza Diagnostic Tests (RIDTs ) should not be used to rule out influenza A , The
sensitivity of currently available RIDT for human influenza strains is variable & suboptimal.
In SARI patients with no epidemiological risk factors for avian influenza A (H7N9 or
H5N1) and MERS-CoV, clinicians should rule out the most common pathogens (e.g.
conventional bacteria and respiratory viruses including seasonal influenza) before
considering an unusual or more highly virulent pathogen.
The only way of knowing with certainty the etiology of a case of SARI is by means
of laboratory diagnosis.
Ideally, every patient meeting the SARI case definition, should be sampled.
Under no circumstances should influenza diagnostic testing delay initiation
of infection control practices or antiviral treatment, if influenza is suspected
clinically and epidemiologically.
14. Clinical Case Management of Influenza Patients with ILI & SARI 2016
14 WHO Expert Team Dr. Ashraf El-adawy
Diagnostic specimen collection for respiratory virus infection in SARI
Respiratory tract specimens are the most important specimens for confirming the diagnosis
of respiratory virus infection.
Upper respiratory tract samples include nasal, naso-pharyngeal, throat swabs, nasal wash in
viral transporting medium (VTM).
For seasonal influenza, nasal or nasopharyngeal samples are best specimens to collect
Throat swabs should be added when novel or zoonotic influenza viruses are suspected.
Specimens should be taken as early as possible in the course of illness as the ability to
detect virus declines with increasing delays.
Viral testing should be done by reverse-transcriptase polymerase chain reaction (RT-PCR)
Respiratory multiplex RT-PCR for parainfluenza, human metapneumovirus, coronavirus,
rhinovirus/enterovirus, adenovirus should be done on negative influenza specimens (48
hour TAT) when there is a clinical indication to detect non-influenza viruses.
The most appropriate specimens for MERS-CoV testing are Lower Respiratory Tract
specimens ( LRT samples are more likely to be positive than URT specimens and virus can
be detected in LRT specimens for longer periods than in URT specimens).
lower respiratory tract secretions are likely more sensitive for detection of both Influenza A,
including H7N9, and MERS-CoV.
In patients with lower respiratory-tract symptoms, in
addition to upper respiratory tract sampling, Collect
lower respiratory tract specimens, i.e. sputum ,
endotracheal aspirate, bronchoalveolar lavage, for
both bacterial and viral testing.
Collect Sputum sample for gram stain and routine culture (if there evidence of Pneumonia
If more invasive samples are collected they should be processed for a wide range
of pathogens e.g Bronchial-alveolar wash for all cultures (bacteria, viruses, fungi
mycobacteria,).
15. Clinical Case Management of Influenza Patients with ILI & SARI 2016
15 WHO Expert Team Dr. Ashraf El-adawy
General laboratory investigations for hospitalized patients
Main Laboratory Test For hospitalized patients For patients admitted at Intensive Care Unit
Full blood count (CBC)
Serum electrolytes
Hepatic function (AST, ALT)
Renal function (BUN, Ceatinine)
GPIC
LDK
Glucose
Urinalysis
Microbiological studies of respiratory
secretions (') and blood cultures if
suspected bacterial infection.
Arterial blood gases
Pulse oxirnetry
Chest x-ray (at admission and to
followup, as per health owe facility
protocols)
Other investigations, according to
established protocols of the health care
facility, such as erythrocyte
sedimentation rate, C-reactive protein
(CRP), and ECG
In addition to the hospitalization
investigations
Coagulation profile
Procalcitonin (if available)
Serial arterial blood gases
Serial chest x ray
Serial electrocardiogram
Importance of early recognition
Routine screening & early recognition of clinical syndromes (i.e. severe sepsis, severe
pneumonia, and ARDS) and implementation of appropriate therapies, improves outcomes
and reduce morality .
In patients with progressive or complicated illness, instigate continuous monitoring of vital
signs (e.g. temperature, blood pressure, pulse, respiratory rate, level of consciousness,
clinical signs of dehydration or shock) & oxygen saturation (pulse oximetry or blood gas
analyses).
Initial treatment decisions should be based on clinical presentation and epidemiological
data and under no circumstances should treatment be delayed pending laboratory
confirmation.
Collect pretreatment blood cultures for potential
bacterial pathogens that can also cause pneumonia and
sepsis (ideally before antimicrobial therapy is initiated)
,this must NOT significantly delay the start of
antimicrobial therapy (>45 minutes).
16. Clinical Case Management of Influenza Patients with ILI & SARI 2016
16 WHO Expert Team Dr. Ashraf El-adawy
Initial severe ILI & SARI treatment
Initial management should include appropriate infection prevention and control procedures,
evidence-based supportive critical care and empiric antibiotic and antiviral therapy while awaiting
diagnostic testing.
1) Early supportive therapy and monitoring :
A) Oxygen therapy for severe disease
In the hospital setting, Give supplemental oxygen therapy immediately to patients (adults
and children) with SARI & Severe ILI who have signs of severe respiratory distress,
hypoxaemia (SpO2 < 90% by pulse oximetry) or shock.
In adults initiate oxygen therapy at 5 L/min and in children at 1-2 l/min using nasal cannula
and measure SpO2 immediately because clinical signs of hypoxaemia are unreliable.
If critically ill, consider starting with higher flow rates (10-15 l/min) using a face mask with
reservoir bag .
Titrate oxygen flow rates to target SpO2 ≥90% in non-pregnant adults and children (or > 92-
95% in pregnant females) using the appropriate delivery device for flow rate.
All areas where patients with SARI are cared for should be equipped with pulse oximeters,
functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal
cannula, simple face mask, and mask with reservoir bag) .
Pulse oximeters measure SpO2 quickly, easily, and reliably but have some limitations.
Obtain an ABG (arterial blood gas analysis) for additional information about PaO2, pH and
PaCO2 in patients who may have severe hypoxaemia, hypercapnea, acidosis, unreliable
pulse oximeter readings, are deteriorating or are on invasive mechanical ventilation.
Do NOT delay oxygen administration when caring for critically ill patients, Appropriate use
of oxygen will optimize quality care, minimizes waste and save lives.
B) Advanced respiratory support
Recognize severe hypoxemic respiratory failure when a patient with severe respiratory
distress is failing standard oxygen therapy as: Patients may continue to have increased work
of breathing or hypoxemia even when standard oxygen therapy is delivered via a face mask
with reservoir bag (flow rates of 10 -15 L/min delivers oxygen concentration, FiO2, between
0.60 and 0.95).
Wherever available, when staff members are trained, institute mechanical ventilation early
in patients with increased work of breathing or hypoxemia that persists despite standard
high flow oxygen therapy (Refractory H ypoxaemia) .
Noninvasive ventilation (NIV) is the delivery of bi-level positive airway pressure through a
tight-fitting mask, however there is insufficient evidence to promote its use in patients with
severe pneumonia or ARDS, unless immunosuppression is also present or disease is mild
without impaired consciousness or cardiovascular insufficiency.
17. Clinical Case Management of Influenza Patients with ILI & SARI 2016
17 WHO Expert Team Dr. Ashraf El-adawy
When NIV used, it should be used as a short trial, Monitor the patient closely in an ICU ,
Because NIV has potential to generate aerosols, use with airborne precautions. If NIV is
unsuccessful, do not delay endotracheal intubation.
2) Antiviral drug therapy :
Adamantanes and Rimantadine are M2 ion channel blockers; they interfere with hydrogen
ion channel activity of the influenza A virus and prevent viral uncoating , thus blocking its
entry into the host cells.
M2 proton channel blockers protect only against the A viruses, however they are ineffective
against all currently circulating influenza virus strains.
Neuraminidase inhibitors (Oseltamivir or Zanamivir) block the viral neuraminidase enzyme,
which is critical in releasing virions from the infected host's cells. These drugs are active
against influenza A and B.
Regarding Neuraminidase inhibitors,They are not cures and do not kill the virus but
interfere with the way the virus multiplies , they shorten flu episodes by a couple of days,
reduce the risk of complications and possibly lower the likelihood that someone will pass on
the virus. Ideally, they should be given as early as possible in an infection.
Hospitalized patients with suspected influenza should be treated empirically with
Neuraminidase Inhibitors (Oseltamivir or Zanamivir) , which will provide protection ,
effective against both influenza A & B viruses .
Oseltamivir is the recommended first- line antiviral agent for neuraminidase-sensitive
influenza virus infection, ideally initiated within 48 hours of symptom onset.
Patients with severe, progressive or complicated illness consistent with a diagnosis of
influenza should be treated with neuraminidase inhibitors as soon as possible, irrespective
of the presence of underlying comorbidities and even if the time elapsed between symptom
onset and first opportunity to treat is >48hrs.
Evidence indicates that the greatest benefit is derived from early oseltamivir treatment.
Therefore, suitable preparations of oseltamivir need to be available at the point of care.
Do not delay initiation of oseltamivir treatment while waiting for influenza testing results.
Clinical judgment is an important factor in antiviral treatment decisions.
The recommended duration of treatment is 5 days, use increased (doubled) doses of
oseltamivir for severely ill patients.
For undifferentiated SARI in which the causative agent is unknown and there is
concern about a novel influenza strain e.g animal influenza viruses like H5N1,H7N9 or
influenza is circulating in the community, empiric treatment with neuraminidase
inhibitors should not be delayed while awaiting the results of diagnostic testing.
18. Clinical Case Management of Influenza Patients with ILI & SARI 2016
18 WHO Expert Team Dr. Ashraf El-adawy
Patients who have severe or progressive clinical illness should be hospitalized and treated
with oseltamivir as soon as possible. Consideration should be given to the use of higher
doses ( up to 150 mg doses of oseltamivir twice daily in adults and double the daily dose in
children), and longer duration of treatment depending on clinical response.
If the clinical course remains severe or progressive, despite ≥5 days of antiviral treatment,
treatment should be continued without a break until virus infection is resolved or there is a
satisfactory clinical improvement (for up to 10 days) , Clinical judgment should be the guide
to extend treatment longer than 5 days for severely ill patients.
Patients with suspected influenza should complete antiviral treatment for a full treatment
course regardless of negative initial test results unless an alternative diagnosis can be
established and clinical judgment suggests that influenza is an unlikely diagnosis.
Clinicians should consider influenza virus infection as a possible cause of any febrile
respiratory illness requiring hospitalization during influenza season and consider testing for
influenza and starting empiric antiviral therapy & Do not wait for laboratory confirmation of
diagnosis.
Oseltamivir Treatment Dosage (Tamiflu®)
Agent, group Treatment usually for 5 days
Oseltamivir
Adults 75-mg capsule twice per day
Children ≥
12 months
15 kg or less 60 mg per day divided into 2 doses
16-23 kg 90 mg per day divided into 2 doses
24-40 kg 120 mg per day divided into 2 doses
>40 kg 150 mg per day divided into 2 doses
Oseltamivir Dosage for Children under one Year
Age Recommended treatment of Oseltamivir for 5 days
<3 months 12 mg twice daily usually for 5 days
3-5 months 20 mg twice daily usually for 5 days
6-11 months 25 g twice daily usually for 5 days
Points to remember:
Pregnant and postpartum women (including those who have had pregnancy loss) are at risk
of severe influenza-related complications
Neuraminidase inhibitors be prescribed for pregnant women and for those up to two weeks
postpartum who have suspected or confirmed influenza.
When considering antiviral treatment, pregnancy should not be considered as
contraindication to Oseltamivir use.
19. Clinical Case Management of Influenza Patients with ILI & SARI 2016
19 WHO Expert Team Dr. Ashraf El-adawy
Pregnant women should receive the same standard dose regimen as adults for antiviral
treatment e.g Oseltamivir (Tamiflu) : 75 mg capsule twice/ day for 5 days in mild
uncomplicated ILI.
Also ,women can continue to breastfeed while being treated with antivirals.
Dose modification should be considered in patients with impaired renal function as serum
concentrations of oseltamivir carboxylate, the active metabolite of oseltamivir, increase
with declining renal function .
For patients with creatinine clearance of 10--30 mL per minute, a reduction of the treatment
dosage of Oseltamivir to 75 mg once daily is recommended.
Intubated patients with influenza illness should receive oseltamivir through a nasogastric
tube .
Antiviral agents should not be used for post‐exposure chemoprophylaxis in healthy children
or adults , Antiviral agents are not a substitute for vaccination .
3) Antibiotic treatment
Patients may have co-infection with bacterial pathogens or other respiratory viruses;
therefore, investigations and/or empiric therapy for other pathogens should also be
considered.
During an influenza outbreak, cases of pneumonia both from influenza and from secondary
bacterial pneumonia may be expected to increase, adding to the high burden of pneumonia
already seen in community settings.
Secondary bacterial infections have been found in approximately 30% of fatal cases.
When pneumonia is present, co-infecting bacteria frequently reported include
Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and
Staphylococcus aureus (which may include Methicillin sensitive Staphylococcus aureus and
Methicillin-resistant Staphylococcus aureus).
When secondary bacterial pneumonia is suspected, treatment with antibiotics should follow
recommendations from national guidelines for community‐acquired pneumonia.
Give empiric, effective antimicrobials to treat all likely pathogens, including community-
acquired pneumonia or health care-associated pneumonia (if infection was acquired in
health care setting) and sepsis. Give within one hour.
Antibiotic treatment should be selected empirically based on local patterns of bacterial
resistance , the individual patient contraindications or allergies, and the national protocol
for CAP ,until the diagnosis is confirmed.
Empiric therapy can then be adjusted on the basis of laboratory results (If microbiologic
results identify pathogen, therapy should be tailored towards this pathogen).
Chemoprophylaxis for close contacts is not generally recommended
20. Clinical Case Management of Influenza Patients with ILI & SARI 2016
20 WHO Expert Team Dr. Ashraf El-adawy
Don not delay commencement of empiric antiviral treatment plus empiric antibiotics for
community-acquired pathogens, while awaiting confirmatory diagnostic test results In Patients
who have severe or progressive clinical illness.
4) Corticosteroids
Corticosteroids should not be used routinely for treatment of influenza virus infection but
should not be withheld from patients with exacerbations of asthma if this forms a normal
part of treating their exacerbation.
Low doses of corticosteroids may be considered for patients in septic shock who require
vasopressors and have suspected adrenal insufficiency.
Prolonged use of or high dose corticosteroids can result in serious adverse events in
influenza virus-infected patients, including opportunistic infection and possibly prolonged
viral replication.
NOTES:
Patients with SARI should be treated cautiously with intravenous fluids, because aggressive
fluid resuscitation may worsen oxygenation especially in settings where there is limited
availability of mechanical ventilation
Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly
progressive respiratory failure and sepsis syndrome and apply supportive care interventions
immediately.
Understand the patient’s co-morbid condition(s) as this will impact the management of
their critical illness and their prognosis.
Clinicians will require guidance on the management of patients presenting with SARI in the
ICU setting, since most severe cases require ICU admission, mechanical ventilation and
frequently multisystem organ support
Implementation of Infection prevention & Control (IPC) measures
Prior to any patient interaction, all healthcare workers (HCWs) have a responsibility to
assess the infectious risk posed to themselves and to other patients, visitors.
Patient Placement
At triage, recognize patients with severe ILI & SARI, give the patient a surgical mask and
place the patient in separate area , If possible, in an adequately ventilated single room away
from other patient care areas.
If single rooms are insufficient for the number of individuals, then apply cohorting
(placement of patients with the same etiological diagnosis in the same designated unit or
ward) to reduce transmission to other patients or health care workers.
Organize the space and process to permit spatial separation , Keep at least 1-2 meter
between each patient with SARI and other individuals not wearing PPE.
When caring for patients with SARI, use standard and droplet precautions at
all times and airborne precautions during certain high-risk procedures.
21. Clinical Case Management of Influenza Patients with ILI & SARI 2016
21 WHO Expert Team Dr. Ashraf El-adawy
A. Standard Precautions: Routinely, For all patients, at all times, in all healthcare settings.
1) Hand hygiene : should be performed before and after any contact with patients and
after contact with contaminated items. Use an alcohol-
based hand product if hands are NOT visibly soiled. Wash hands with soap and running
water when visibly dirty or contaminated with proteinaceous material.
2) Respiratory Etiquette (i.e. covering the mouth and nose during coughing or sneezing
with a tissue, sleeve or flexed elbow), followed by hand hygiene and disposing tissue
immediately.
3) Waste management and environmental cleaning : Cleaning can be done with water and
neutral detergents. Only surfaces that enter contact with patient skin/mucosa and
surfaces frequently touched by health care worker require disinfection after cleaning.
4) Safe injection procedures and sharps disposal
5) Appropriate personal protective equipments (PPE): If direct contact with blood or
body fluids, secretions, excretions, mucous membranes, or non-intact skin is
anticipated, then use hand hygiene and gloves. If there is a risk of splashes onto
the health care workers body use a gown also. If there is a risk of splashes onto
the body and face, then use medical mask and eyewear also.
B. Droplet Precautions: (should be implemented empirically):
When caring for patients with SARI, droplet precautions are recommended in addition to
standard precautions. Critical additional measures under droplet precautions include:
1) The use of a medical-surgical mask when within one metre of a patient.
2) Physically maintaining distance between the infected patient and other persons by
patient placement in single room, cohorted area, or separated from others by at least 1
metre.
3) Limiting patient movement out of the hospital room and having the patient use a
medical-surgical mask, if tolerated, when they are outside of their room.
C. Airborne Precautions:
Airborne precautions should be used during certain procedures with an increased risk of
infection transmission, When performing an aerosol generating procedures (AGMPs) such
as aspiration or open suctioning of respiratory tract secretions, intubation, cardiopulmonary
resuscitation, and bronchoscopy.
Whenever possible, AGMPs should be performed in an airborne infection isolation room
(Negative pressure room).
Use PPE including gloves , long-sleeved gowns ,a particulate respirator with seal check (N95
or equivalent) and face/eye protection should be used by all HCWs present in a room where
an AGMP is being performed on a patient suspected or confirmed to have SARI infection.
There are two main types of masks :
1) Medical-surgical masks are masks that are sufficient for use when within one metre
of patient with ARI as part of droplet precaution interventions. However, these
masks do not completely seal around the mouth and nose.
22. Clinical Case Management of Influenza Patients with ILI & SARI 2016
22 WHO Expert Team Dr. Ashraf El-adawy
2) Facial particulate respiratory masks completely seal around the mouth and nose.
These masks are used when there is a concern for aerosolized particles capable of
spreading infection
Limit the number of people entering the assigned area to the minimum number required for
patient care ,Instruct them on personal protection equipment (PPE) use and hand hygiene.
Limit visitors to those essential for support. Advise that anyone who is at increased risk of
severe disease does not care for the ill person.
Isolation precautions for hospitalized patients with influenza symptoms should be
continued for 7 days after onset of illness or 24 hours after the resolution of fever and
respiratory symptoms, whichever is longer, while a patient is in a health care facility.
Infection Control Precautions in Specific Situations When Caring
For Patients with Infectious Acute Respiratory Diseases (ARDS)
SCENARIO Hand
hygiene
Gloves
Medical
Mask
Medical
goggles
Gown N95
FOR ROUTINE CARE: when working in direct contact with patients Standard and Droplet Precautions should
always be applied
G Before and after patient contact 4 4
G If direct contact with blood and body fluids,
secretions. , excretions, mucous membranes 4 4
G If there is risk of splashes into the body 4 4 4 4
G If there is risk of splashes into the body and
face 4 4 4 4 4
FOR AEROSOL GENERATING PROCEDURES: wear a particulate respirator and eye protection. Perform the
procedure in a adequately ventilated room. Avoid unnecessary individuals in the room
G Resuscitation, intubation, aspiration of
respiratory tract and bronchoscopy
4 4 4 4 4
FOR LABORATORY SPECIMENS COLLECTION
G Blood sample, (if performed during the acute
infection phase) 4 4 4
G Nasal swabs and nasal wash 4 4 4 4 4
G Nasopharyngeal aspirate, nasopharyngeal
swab, throat swab or bronchial aspirate 4 4 4 4 4
Discharge criteria for hospitalized patients :
Patient showing clinical signs of improvement and proof of responding to antiviral treatment as
evidenced by the followings:
Vaccination of all health care workers is strongly recommended to protect
from infection and to reduce risk of nosocomial infection of patients
23. Clinical Case Management of Influenza Patients with ILI & SARI 2016
23 WHO Expert Team Dr. Ashraf El-adawy
Patient becomes afebrile
Absence of dyspnoea
Satisfactory oral fluid tolerance
No signs of dehydration
Respiratory rate ≤30 bpm
Oxygen saturation ≥ 92%
Underlying chronic health conditions not exacerbated in patients in high‐risk group for
complication.
Guide to assessment and management of ILI
(Policy of Laboratory testing and hospital admission for ILI Cases) :
* STEP 1 Confirm Patient Presents With Influenza-like Illness
* STEP 2 Conduct Illness-Severity Assessment
* STEP 3 Assess for Co-morbid Conditions
Accordingly cases can be classified into:
1. Mild ILI (Group 1) :
Patients with ILI clinical case definition in low risk people in the absence of other
diagnoses. They will not require laboratory confirmation, or admission to hospital,
only symptomatic treatment at home.
2. Mild ILI in high risk group (Group 2) :
Patients with ILI clinical case definition in high risk people (for serious influenza
complications), with stable medical condition and no serious or life-threatening
influenza complication, and in the absence of other diagnoses. Patients of this group
Do not require laboratory confirmation, or admission to hospital only antiviral
treatment at home.
3. Severe ILI (Group 3) :
Patients with ILI clinical case definition (whether in high risk people or not) ,with
Unstable medical condition and vulnerable to serious or life-threatening influenza
complication, and in the absence of other diagnoses.. Those Patients are considered
vulnerable to severe outcomes should be the focus of early identification. They will
require laboratory confirmation, and hospital admission & antiviral treatment in the
hospital .
24. Clinical Case Management of Influenza Patients with ILI & SARI 2016
24 WHO Expert Team Dr. Ashraf El-adawy
CASE MANAGEMENT OF IFUENZA LIKE ILLNESS (ILI)
ILI: Fever ≥ º C AND Cough or sore throat, with onset within the last seven days, in the absence
of other known causes other than influenza
Does the patient has any symptoms
& signs of severe illness ?
No
Does the patient has underlying
medical conditions or at a high risk
group for influenza complication?
SEVERE SYMPTOMS:
mmHg.
Sever persistent vomiting.
Sever dehydration &signs of imminent
shock.
Altered Level of consciousness (New
days in spite
of treatment.
Additional Symptoms in children:
Not eating or drinking enough fluids.
Not waking up or interacting
Irritability, not wanting to play or be-
held.
Fast or laboured breathing
Hospitalization
Testing:
Upper respiratory tract specimens :
Nasopharyngeal (NP) -preferred OR nasal
swabs.
lower respiratory tract specimens:
Bronchoalveolar lavage , endotracheal
aspirate (intubated patients).
Collect specimens before antivial
therapy initiated
Consider testing Respiratory speci-
mens for influenza by RT-PCR
Store in refrigerator while waiting
transport (DO NOT FREEZE).
Sputum (if evidence of Pneumonia).
Pretreatment blood culture before anti-
microbial therapy is initiated.
Treatment:
hours.
Do not delay treatment pending laboratory
confirmation of influenza.
Use clinical Judgment to decide additional
antibiotic therapy for community-acquired
pathogens is needed.
Prescribing oseltamivir:
days, however longer treatment regimen
days of treatment: con-
days)
Indications for ICU admission:
)
or respiratory exhaustion despite
maximum oxygen saturation
Progressive hypercapnia
Presence of compromised hea-
modynamics
Signs of sepsis and imminent
shock
Multi-organ failure
Mild ILL + No
Risk factors
Mild ILL + Risk
factors
Home isolation Home isolation
Testing:
No influenza lab
testing
Severe ILI
Testing:
No influenza laboratory
testing
Treatment:
Symptomatic
treatment
No Antiviral
Treatment:
Treat empirically with
antiviral (oseltamivir)
as soon as possible
The usual dose is:
≥ Kgm
In smaller children use
weight based dosing.
Home Care Precautions
i)
hours
after fever has resolved)
ii) Instruction on infection prevention; Rein-
force hand hygiene and respiratory eti-
quette measures.
iii) When return for care: close home obser-
hours.
If the patient develops severe symptoms
at home
High risk groups for serious influenza copmplications:
Pregnant women (up to two weeks post partum)
≥ years
Persons with the following underlying conditions at any age:
. Chronic Broncho‐pulmonary diseases ( Including asthma & COPD & OSA )
. Chronic cardiovascular diseases ( Including CHF& MI except hypertension )
. Chronic neurologic disorder (Cerebral palsy, stroke, multiple sclerosis,muscular dystrophy, seizure disorders etc)
. Immune suppressed patients (HIV, immunosuppressive medications, malignancy, long term steroids )
. Haemoglobinopathies
. Chronic liver or renal failure
. Metabolic disorder (specially Diabetes mellitus)
. Morbid obesity - ≥ )
Yes
No Yes
Yes
No influenza testing recommended
Additional work up &follow up as
clinically indicated
No
Designed by :Dr .Ashraf eladawy , TB TEAM EXPERT–WHO
25. Clinical Case Management of Influenza Patients with ILI & SARI 2016
25 WHO Expert Team Dr. Ashraf El-adawy
Multiple choice questions
Question 1
Influenza is transmitted by droplets and is probably airborne.
A. True
B. False
Question 2
For how long is an otherwise healthy adult with symptomatic influenza infectious to others?
A. Only while symptoms are present
B. For about one day before the onset of the symptoms until about five to seven days
thereafter
C. For about three days before the onset of the symptoms until about seven days
thereafter
D. Non of the above
Question 3
Which of the following is NOT an appropriate infection prevention and control practices for
influenza in healthcare settings?
A. Perform hand hygiene before and after contact with patient and contaminated
surfaces
B. Always use a particulate respirator (for example, N95), gloves and gown when in
close contact with the patient.
C. Have the patient use a medical-surgical mask when outside the hospital room.
D. Place patient in single room, cohorted or at least 1 metre from other patients.
E. Non of the above
Question 4
A patient with severe influenza like illness is admitted to the ICU. Which of the following
precautions are indicated?
A. Airborne precautions when you are carrying out intubation.
B. Standard precautions at all times
C. Droplet precautions at all times
D. B and C
E. A, B and C
Question 5
During performing aerosol generating procedures as bronchoscope , nasopharyngeal sampling
,intubation:
A- N95 respirator and all PPE is required
B- Negative pressure room is required
C- Minimize health care personal during the procedure
D- None of the above
E- All of the above
Question 6
Coughing etiquette includes which of the following:
A. Washing your hands after coughing
B. Turn your head away from food/people when coughing
C. Covering your mouth when coughing
26. Clinical Case Management of Influenza Patients with ILI & SARI 2016
26 WHO Expert Team Dr. Ashraf El-adawy
D. Cough/sneeze into your elbow area
E. All of the above
Question 7
A basic precaution to prevent the contraction of the flu is _______________.
A. washing hands often with soap and water
B. Avoid touching the eyes and nose
C. Avoid contact with those known to be sick
D. All of the above
Question 8
Which of the following common symptoms is not usually a feature of flu in adults?
A. Chills and a high fever.
B. Muscle aches and pains.
C. A runny nose, sore throat and a cough.
D. Vomiting and diarrhoea.
Question 9
During a case of the flu, which of the following is a sign you need to see a doctor urgently?
A. Dry cough.
B. Sore throat.
C. Runny nose.
D. Shortness of breath.
Question 10
Patients at high risk for developing complications from seasonal influenza include all of the
following except:
A. > 65 years old
B. A 35 year old busy mother who does not want the flu
C. Diabetics
D. Asthmatics
Question 11
The most common respiratory complications of influenza are:
A. Primary viral pneumonia
B. Secondary bacterial pneumonia
C. Common cold
D. Combined viral-bacterial pneumonia
E. Gastroenteritis (commonly called the stomach flu)
Question 12
Complications of influenza infection include:
A. S. aureus pneumonia
B. Reye’s syndrome
C. Persistent hyponatremia
D. Myositis and rhabdomyolysis
E. Chorioretinitis
Question 13
The best way to avoid the flu include...
A. Getting a yearly flu shot
B. Washing your hands often
27. Clinical Case Management of Influenza Patients with ILI & SARI 2016
27 WHO Expert Team Dr. Ashraf El-adawy
C. Avoiding unnecessary contact with a lot of people during peak flu months
D. Take antiviral medications
E.All of the above
Question 14
If during flu season a patient starts to get better after 3 or 4 days of flu-like symptoms and then
on day 5 or 6 starts to feel worse, the most likely diagnosis is:
A. Viral (influenza) pneumonia.
B. Bacterial pneumonia.
C. Relapsing influenza.
D. Reinfection with influenza virus.
E. Infection with different virus
Question 15
A patient with influenza-like illness symptoms and signs of dehydration does not have a
complicated infection and should NOT be treated with antivirals or considered for
hospitalization.
A. True
B. False
Question 16
In patients with severe hypoxaemia from shunt physiology, the delivery of oxygen therapy by
nasal cannula at 4 l/min provides sufficient FiO2 to maintain aSpO2>90 %.
A. True
B. False
Question 17
You included influenza in differential diagnosis of a patient with severe acute respiratory
infection. It is appropriate to wait for laboratory confirmation of influenza virus infection
before starting antiviral treatment?
A. True
B. False
Question 18
A patient is admitted to the medical wards with community-acquired pneumonia and treated
with appropriate antimicrobials. After 48 hours the condition worsens and the patient is
transferred to the ICU. Specimens for influenza were not yet collected. Which statement is
correct about collecting specimens now?
A. Specimens for influenza virus detection should not be taken as it is too late
B. Tracheal aspirate specimens are not appropriate sample to submit
C. Specimens should be stored at room temperature while awaiting transport to the
laboratory
D. Specimens should be placed in viral transport medium once collected
Question 19
A patient is admitted with respiratory failure due to rapidly progressing pneumonia and ARDS.
As part of the differential diagnosis you consider
influenza virus infection. Which of the following statements regarding therapy is correct?
28. Clinical Case Management of Influenza Patients with ILI & SARI 2016
28 WHO Expert Team Dr. Ashraf El-adawy
A. Oseltamivir therapy should be delayed pending confirmation of the diagnosis in order
to avoid selecting for resistant virus
B. Oseltamivir may be administered at a dosage of 150mg twice a day
C. Oseltamivir cannot be used in ventilated patients as they cannot take medications
orally
D. Do not give antibiotics for community acquired pneumonia until diagnostic tests
confirm bacterial infection
Question 20
For that same patient, results of the rapid influenza test are reported as negative. Which of the
following should you NOT do?
A. Stop antiviral therapy as influenza infection is unlikely
B. Send a repeat specimen for RT-PCR testing if confirmation will affect clinical
management
C. Continue treatment for bacterial pneumonia
D. Continue antiviral treatment and infection control measures as rapid tests cannot
exclude the diagnosis of influenza virus infection
Question 21
The antiviral drugs Zanamivir (Relenza) and Oseltamivir (Tamiflu) combat the flu virus by which
of the following mechanisms?
A. Degrading viral DNA
B. Blocking entry of the virus into the host cell
C. Blocking the release of virions from the host cell
D. All of the above
Question 22
With regard to anti-influenza drugs which of the following statements are true:
A. Amanantidine is effective as a prophylactic agent against influenza B virus
B. The mode of action of Amanantidine involves blockage of an ion channel and
prevention of viral uncoating
C. Neuroaminidase inhibitors have no activity against influenza B virus
D. Zanamivir should not be used in patients with history of egg allergy
E. Aciclovir has a proven efficacy against influenza A viruses
Question 23
Which of these statements about neuraminidase inhibitors is true? Choose 1 answer:
A. They work best when given early in infection
B. They cure influenza
C. They are no longer effective because the virus has developed resistance to them
D. They are only active on seasonal flu strains
Question 24
Prescribe antiviral treatment for :
A. Hospitalized patients with severe, complicated influenza-like illness
B. Outpatients with Mild influenza-like illness
C. Outpatients with Mild influenza-like illness who are at risk of complications
D. All of the above
29. Clinical Case Management of Influenza Patients with ILI & SARI 2016
29 WHO Expert Team Dr. Ashraf El-adawy
Question 25
You admit a 24 year old HIV-infected pregnant woman with severe respiratory distress and
hypoxia. She gives a 4 day history of shortness of breath and fever. On chest X-ray you observe
diffuse infiltrates. You suspect severe influenza virus infection. Which of the following
statements is NOT correct?
A. The differential diagnosis should include pneumocystis pneumonia and tuberculosis
B. Oseltamivir should be avoided as it is known to be teratogenic
C. Oseltamivir is the recommended therapy in severely ill pregnant women
D. Give empiric antiiotics for community acquired pneumonia
Question 26
A number of complications are associated with influenza ,which of the following is NOT one of
these complications?
A. Nephritis.
B. Pneumonitis. b
C. Myocarditis.
D. Encephalitis.
E. Death.
Question 27
Severe acute respiratory illness (SARI) has been documented as a common feature of which of
the following recent emerging respiratory pathogens:
A. Avian influenza A (H7N9)
B. Avian influenza A (H5N1)
C. Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
D. All of the above
E. Non of the above
Question 28
A patient with severe pneumonia, has been receiving high flow oxygen (15 l/min by face mask
with reservoir bag) for 1 hour but continues to have signs of severe respiratory distress with a
RR of 40 and SpO2 of 85%. Which is the most appropriate next step?
A. Fluid bolus of 1 litre of NS
B. Continue the same management
C. Initiate noninvasive ventilation with BIPAP
D. Intubation and mechanical ventilation
Question 29
A 50 year old woman presents to your hospital with a suspected infection and shock. For initial
diagnostic and therapeutic considerations, which of the following is correct?
A. Diagnosis cannot be influenza because flu does not present with hypotension
B. Consider non-influenza etiologies of septic shock only
C. Empiric therapy should be initiated as soon as possible and should consider multiple
etiologies of septic shock, such as influenza and bacterial pathogens.
D. Wait until a definitive diagnosis is made before initiating antimicrobial therapy
E. All of the above
Question 30
Using aspirin as an antipyretic in children who are down with flu may lead to a fatal side-effect called:
A. Meningitis
B. Kawasaki Disease
C. Encephalitis
D. Reye's Syndrome
30. Clinical Case Management of Influenza Patients with ILI & SARI 2016
30 WHO Expert Team Dr. Ashraf El-adawy
References:
1. Critical care training (severe forms of influenza infection) - WHO 2012
2. Community case management during an influenza outbreak- WHO 2011.
3. National guidelines of influenza A/H1N1 pandemic for health care providers (Pakistan ) 2009.
4. Clinical management of human infection with pandemic (H1N1) -WHO 2009
5. Antiviral agents for the treatment and chemoprophylaxis of influenza ACIP, 2011.
6. Guidance on the use of antiviral agents for the treatment and prophylaxis of influenza, 2014-2015 ,
Influenza Subgroup of the Scientific Advisory Committee of the Health Protection Surveillance Centre
(HPSC)
7. Algorithm to assist in decisions on testing and treatment for novel influenza A (H1N1) virus in
Arizona,2009
8. Operational guideline for ARI, ILI & SARI surveillance- Public Health Laboratory Department of Public
Health -Ministry of Health Thimphu: Bhutan 2012
9. Severe Acute Respiratory Infection(SARI) Jan 2015 NHS
10.Malaysia Influenza Surveillance Protocol -2015
11. Guidance for the Management of Severe Acute Respiratory Infection in the Intensive Care ( Prepared
on behalf of the Canadian Critical Care Society -2013)
12.Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI) 2013
13.Severe acute respiratory illness (SARI)* Screening tool- Public Health Agency of Canada
14.Operational Guidelines for Sentinel Severe Acute Respiratory Infection (SARI) Surveillance -
September 2014
15.Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute
Respiratory Infection SARI-Version APRIL 2009 Pan American health orginization
16.Severe Acute Respiratory Infection (SARI) Guidelines-Canada 2013
17. ILI & SARI Surveillance Second Edition 2014
18.IMAI District Clinician Manual: Hospital Care for Adolescents and Adults. Geneva: WHO 2012.
19.Clinical management of severe acute respiratory infection when Middle East respiratory syndrome
coronavirus (MERS-CoV) infection is suspected- Interim guidance - July 2015
20.Global epidemiological surveillance standards for influenza-who 2013
21.WHO Regional Office for Europe guidance for sentinel influenza surveillance in humans- May 2011
22.WHO Interim Global Epidemiological Surveillance Standards for Influenza (July 2012)
23.Questions and answers on seasonal influenza - Regional Office for the Americas of the World Health
Organization 2015
24.Respiratory MCQ’s
25.Multiple choice questions against infectious disease- UIK updated version October 2015
26.Infection prevention and control of epidemic - and pandemic - prone acute respiratory diseases in
health care 2007
27.The WHO pulse oximetry training manual - WHO, 2011
28.Oxygen is an essential medicine: a call for international action - WHO-ITUTLD, 2009
29.Use of influenza rapid diagnostic test - WHO, 2011
30.Course "Special Considerations when Caring for the Pregnant Patient" –WHO.