Influenza
Influenza is acommon infectious disease caused by the Influenza virus.
Presentation
Onset is sudden with fever, rhinorrhea, sore throat and headache. Severe myalgias coupled with respiratory tract symptoms are typical of influenza [7]. Patients may also have red, watery eyes and cough. There can also be tachycardia and dyspnea but with hypotension. Vomiting and diarrhea may also occur, but are rare findings associated with the disorder.
Respiratoric
Cough
- Simple acts such as coughing, sneezing and even laughing can transmit the infection. Signs and symptoms Signs and symptoms include sudden high grade fever associated with chills, sore throat, runny nose and cough.[symptoma.com]
- An 88-year-old woman presented to our emergency room with complaints of fever, coryza, barking cough and generalised fatigue for 2 days. Physical examination showed stridor, tachypnoea with use of accessory muscles of respiration on admission.[ncbi.nlm.nih.gov]
- Yet differing symptoms of the cold are: sore throat; productive, phlegmy coughs; and sneezing.[3dscience.com]
- […] mild to moderate, hacking cough common; often severe with painful cough For most people, the flu lasts 1 or 2 weeks, but it can last for up to 1 month.[medbroadcast.com]
- Cover your mouth and nose with a tissue when you cough or sneeze, then put it in the trash. If you don't have a tissue, cough or sneeze into your upper arm, not your hands. What Can Parents Do? Get the flu vaccine every year.[kidshealth.org]
Sneezing
- If you don't have a tissue, cough or sneeze into your elbow or sleeve. Wash your hands often with soap and water, especially after you cough or sneeze. If you don't have soap and water, you can use an alcohol-based hand cleaner.[girlshealth.gov]
- Sneeze into your elbow Sneeze into your elbow instead of your hands, or cover your face with a tissue when you cough or sneeze and throw used tissues in a rubbish bin. Clean your hands Wash your hands thoroughly and often.[health.nsw.gov.au]
- Contain your coughs and sneezes. Cover your mouth and nose when you sneeze or cough. To avoid contaminating your hands, cough or sneeze into a tissue or into the inner crook of your elbow. Avoid crowds.[mayoclinic.org]
- Yet differing symptoms of the cold are: sore throat; productive, phlegmy coughs; and sneezing.[3dscience.com]
- Cover your mouth and nose with a tissue when you cough or sneeze, then put it in the trash. If you don't have a tissue, cough or sneeze into your upper arm, not your hands. What Can Parents Do? Get the flu vaccine every year.[kidshealth.org]
Common Cold
- Due to the fact that influenza infections and common colds spread easily via droplets and contact, public prevention measures, such as hand washing and facial masks, are recommended for influenza prophylaxis.[ncbi.nlm.nih.gov]
- How can I tell the difference between a common cold and influenza? Many cold and influenza symptoms are similar. Both common cold and influenza are caused by viruses. There are some differences with influenza.[my.clevelandclinic.org]
- Symptoms of the flu come on suddenly and are worse than those of the common cold. They may include Body or muscle aches Chills Cough Fever Headache Sore throat Is it a cold or the flu? Colds rarely cause a fever or headaches.[osap.org]
- Hand Hygiene Proper hand washing significantly reduces the spread of the diseases like flu and the common cold.[health.state.mn.us]
- Unlike the common cold, the flu can cause serious illness and can be life-threatening. Each year, influenza is estimated to be responsible for at least 9 million cases of disease, 140,000 hospitalizations, and 12,000 deaths.[healthvermont.gov]
Dry Cough
- The dry cough and fatigue of influenza can last two to three weeks. Signs that influenza is getting worse include fever, shaking chills, and shortness of breath.[my.clevelandclinic.org]
- Influenza symptoms often begin suddenly, with fever, headache, tiredness, dry cough, sore throat, nasal congestion and body aches. The best way to prevent influenza is to get vaccinated each year.[dhs.wisconsin.gov]
- Infected individuals usually experience a rapid onset of flu symptoms which typically include: muscle aches, high fever, head ache, chills, fatigue, dry cough and runny/stuffy nose.[3dscience.com]
- A bout of the flu typically follows this pattern: Days 1–3: Sudden appearance of fever, headache, muscle pain and weakness, dry cough, sore throat and sometimes a stuffy nose. Day 4: Fever and muscle aches decrease.[betterhealth.vic.gov.au]
- The symptoms of flu can include: fever sore throat dry cough headache muscle and joint pain tiredness or extreme exhaustion In the elderly, fever may be absent and the only signs and symptoms of flu may be: confusion shortness of breath worsening of a[conditions.health.qld.gov.au]
Nasal Congestion
- Influenza symptoms often begin suddenly, with fever, headache, tiredness, dry cough, sore throat, nasal congestion and body aches. The best way to prevent influenza is to get vaccinated each year.[dhs.wisconsin.gov]
- Influenza usually comes on suddenly and may include these symptoms: fever, headache, malaise (a feeling of being ill and without energy that can be extreme), cough, sore throat, nasal congestion and body aches.[fda.gov]
- Common signs and symptoms of the flu include: Fever over 100.4 F (38 C) Aching muscles Chills and sweats Headache Dry, persistent cough Fatigue and weakness Nasal congestion Sore throat When to see a doctor Most people who get the flu can treat themselves[mayoclinic.org]
- The most common side effects seen with administration of the nasal vaccine include runny nose or nasal congestion in recipients of all ages, fever more than 100 degrees Fahrenheit in children two to six years of age, and sore throat in adults.[fda.gov]
- […] dry cough headache muscle and joint pain tiredness or extreme exhaustion In the elderly, fever may be absent and the only signs and symptoms of flu may be: confusion shortness of breath worsening of a chronic condition Symptoms Flu Cold Runny nose or nasal[conditions.health.qld.gov.au]
Entire body system
Fever
- Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998).[ncbi.nlm.nih.gov]
- A 39-year-old woman received a seasonal influenza vaccine in November 2015 and subsequently experienced malaise, low-grade fever, and chest discomfort.[ncbi.nlm.nih.gov]
- This is a case of a 60-year-old man with chronic idiopathic pulmonary fibrosis, with fever, arthralgias and rash characterised by extensive erythematous plaques on his limbs and trunk 5â ‰days after influenza vaccination.[ncbi.nlm.nih.gov]
- An 88-year-old woman presented to our emergency room with complaints of fever, coryza, barking cough and generalised fatigue for 2 days. Physical examination showed stridor, tachypnoea with use of accessory muscles of respiration on admission.[ncbi.nlm.nih.gov]
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, also known as drug-induced hypersensitivity syndrome (DHIS), is an acute, potentially life-threatening disease that includes skin rash, fever, haematological abnormalities and multiorgan[ncbi.nlm.nih.gov]
Chills
- Moderate to high fever Dry cough Headache Sore throat Chills Runny nose Loss of appetite Muscle aches Tiredness Many conditions — such as a common cold, diarrhea, and vomiting — are called "the flu," but are not influenza.[my.clevelandclinic.org]
- They may include Body or muscle aches Chills Cough Fever Headache Sore throat Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an upset stomach.[fpnotebook.com]
- People infected with the seasonal flu virus feel miserable with fever, chills, muscle aches, coughing, congestion, headache and fatigue for a week or so.[niaid.nih.gov]
Fatigue
- An 88-year-old woman presented to our emergency room with complaints of fever, coryza, barking cough and generalised fatigue for 2 days. Physical examination showed stridor, tachypnoea with use of accessory muscles of respiration on admission.[ncbi.nlm.nih.gov]
- Infected individuals usually experience a rapid onset of flu symptoms which typically include: muscle aches, high fever, head ache, chills, fatigue, dry cough and runny/stuffy nose.[3dscience.com]
- The dry cough and fatigue of influenza can last two to three weeks. Signs that influenza is getting worse include fever, shaking chills, and shortness of breath.[my.clevelandclinic.org]
- […] flu·en·za \ ˌin-(ˌ)flü-ˈen-zə \ 1 a : an acute, highly contagious, respiratory disease caused by any of three orthomyxoviruses: (1) or influenza A : moderate to severe influenza that in humans is marked especially by sudden onset, fever, sore throat, fatigue[merriam-webster.com]
Weakness
- Despite treatment using intravenous immunoglobulin, her condition continued to get worse with new bulbar and respiratory muscle weakness.[ncbi.nlm.nih.gov]
- They might have: fever chills headache muscle aches dizziness loss of appetite tiredness cough sore throat runny nose nausea or vomiting weakness ear pain diarrhea Babies with the flu also may suddenly seem fussy or just "not look right."[kidshealth.org]
- A bout of the flu typically follows this pattern: Days 1–3: Sudden appearance of fever, headache, muscle pain and weakness, dry cough, sore throat and sometimes a stuffy nose. Day 4: Fever and muscle aches decrease.[betterhealth.vic.gov.au]
- Fever, cough, shaking chills, body aches, and extreme weakness are common symptoms. • You can catch influenza from people who cough, sneeze, or even just talk around you.[vaccineinformation.org]
High Fever
- Moderate to high fever Dry cough Headache Sore throat Chills Runny nose Loss of appetite Muscle aches Tiredness Many conditions — such as a common cold, diarrhea, and vomiting — are called "the flu," but are not influenza.[my.clevelandclinic.org]
- fever lasting more than three days low blood pressure Possible complications of the flu pneumonia and respiratory failure worsening of chronic health conditions Other severe outcomes of the flu hospitalization death How the flu is diagnosed The flu is[canada.ca]
- Infected individuals usually experience a rapid onset of flu symptoms which typically include: muscle aches, high fever, head ache, chills, fatigue, dry cough and runny/stuffy nose.[3dscience.com]
- People usually become very sick with several, or all, of the following symptoms: Cough, often becoming severe Extreme exhaustion Fatigue for several weeks Headache High fever Runny or stuffy nose Severe aches and pains Sneezing at times Sometimes a sore[cedars-sinai.org]
- fever for more than three days If you are at high risk for developing complications, your doctor may want you to take antiviral medications, such as Tamiflu.[sepsis.org]
Gastrointestinal
Loss of Appetite
- Moderate to high fever Dry cough Headache Sore throat Chills Runny nose Loss of appetite Muscle aches Tiredness Many conditions — such as a common cold, diarrhea, and vomiting — are called "the flu," but are not influenza.[my.clevelandclinic.org]
- Usually they include the sudden appearance of: fever cough muscle aches and pain Other common symptoms may include: headache chills fatigue (tiredness) loss of appetite sore throat runny or stuffy nose Some people (especially children) may also have:[canada.ca]
- They might have: fever chills headache muscle aches dizziness loss of appetite tiredness cough sore throat runny nose nausea or vomiting weakness ear pain diarrhea Babies with the flu also may suddenly seem fussy or just "not look right."[kidshealth.org]
- Other common symptoms include sore throat, runny nose, headache, chills, loss of appetite, and fatigue. Some adults will also experience stomach ache, vomiting and diarrhea, but these symptoms are more common with children.[ccohs.ca]
Abdominal Pain
- Influenza A symptoms If you have influenza, you will have some or all of these symptoms: fever and chills headache and muscle aches feeling tired and weak sneezing, and stuffy or runny nose sore throat and cough Children may also have abdominal pain,[healthdirect.gov.au]
- pain in children Rare Mild Children are more likely to have gastrointestinal symptoms (nausea, vomiting and diarrhoea).[conditions.health.qld.gov.au]
Cardiovascular
Chest Pain
- You should also get help straight away if you feel chest pain , short of breath, dizzy or confused , or you are vomiting a lot.[healthdirect.gov.au]
- When to seek immediate attention Visit your nearest hospital if you develop any of these serious symptoms: shortness of breath, rapid breathing or difficulty breathing chest pain bluish or grey skin colour bloody or coloured mucus/spit sudden dizziness[canada.ca]
- When to call the doctor You should consult your doctor if symptoms such as clouded/altered consciousness, breathlessness, or severe chest pain occur, and if you are concerned.[medinfo.co.uk]
- See your doctor if you are concerned, and seek immediate medical attention if you experience any of the following symptoms: difficulty breathing chest pain sudden dizziness confusion severe vomiting fever with a rash.[betterhealth.vic.gov.au]
Tachycardia
- There can also be tachycardia and dyspnea but with hypotension. Vomiting and diarrhea may also occur, but are rare findings associated with the disorder.[symptoma.com]
- Typical signs and symptoms include the following (not necessarily in order of prevalence): Cough and other respiratory symptoms Fever Sore throat Myalgias Headache Nasal discharge Weakness and severe fatigue Tachycardia Red, watery eyes Cough and other[emedicine.medscape.com]
Eyes
Photophobia
- Ocular symptoms develop in some patients with influenza and include photophobia, burning sensations, or pain upon motion. Some patients with influenza develop rhinitis of varying severity, but it is generally not the chief symptom.[emedicine.medscape.com]
Skin
Flushing
- The skin may be warm and flushed, especially on the face. The mouth and throat may redden, the eyes may water, and the whites of the eyes may become bloodshot. People, especially children, may have nausea and vomiting.[merckmanuals.com]
Musculoskeletal
Myalgia
- Acute febrile illness is generally limited to upper respiratory symptoms and several constitutional symptoms, including headache, lethargy, and myalgia. However, influenza A virus is a cause of severe morbidity and mortality worldwide.[ncbi.nlm.nih.gov]
- It is marked by inflammation of the NASAL MUCOSA; the PHARYNX; and conjunctiva, and by headache and severe, often generalized, myalgia.[fpnotebook.com]
- Women are followed throughout pregnancy through twice weekly surveillance for influenza symptoms ( 1 of myalgia, cough, runny nose, sore throat, or difficulty breathing) and have mid-turbinate nasal swabs collected for influenza virus testing during[ncbi.nlm.nih.gov]
- Influenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough.[ncbi.nlm.nih.gov]
Arthralgia
- This is a case of a 60-year-old man with chronic idiopathic pulmonary fibrosis, with fever, arthralgias and rash characterised by extensive erythematous plaques on his limbs and trunk 5â ‰days after influenza vaccination.[ncbi.nlm.nih.gov]
- The most common systemic adverse events were drowsiness, irritability, loss of appetite, fatigue, muscle aches, headache, arthralgia, and gastrointestinal tract symptoms.[pediatrics.aappublications.org]
Neurologic
Headache
- Some antiviral drugs may be used if needed along with painkillers to relieve headaches and muscle pain.[symptoma.com]
- They may include Body or muscle aches Chills Cough Fever Headache Sore throat Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an upset stomach.[fpnotebook.com]
- Acute febrile illness is generally limited to upper respiratory symptoms and several constitutional symptoms, including headache, lethargy, and myalgia. However, influenza A virus is a cause of severe morbidity and mortality worldwide.[ncbi.nlm.nih.gov]
Guillain-Barré Syndrome
- Cerebral Spinal Fluid study showed normal cell counts with elevated protein and nerve conduction study showed reduced diffuse compound muscle action potential amplitudes suggesting a diagnosis of Guillain-Barré syndrome.[ncbi.nlm.nih.gov]
- At the time, doctors thought the vaccine triggered Guillain-Barré syndrome, but more recent evidence makes this connection uncertain.[merckmanuals.com]
- […] eggs People who have had a severe reaction in the past after getting the flu shot People who are sick with a fever (these people should get vaccinated after they have recovered) Babies who are age 6 months old or younger People who have a history of Guillain-Barré[cedars-sinai.org]
Workup
Laboratory tests
- Complete blood count
- Nasal or throat wash
- Nasal or throat swab
- PCR
- Cell-culture based tests
- FLU OIA test and QUICKVUE Influenza test based on detection of viral antigens by using monoclonal antibodies [7].
- ZSTATFLU test based on detection of viral neuraminidase using a substrate of colour-changing enzyme.
- Alere I Influenza A & B test a new point-of-care influenza test that delivers highly accurate molecular results in less than 15 minutes, approved by FDA in June 2014.
Imaging
Imaging studies are generally not required. In case of complications such as bacterial pneumonia, chest radiography may be advised.
Test results
A clinical examination and history is sufficient to form a diagnosis. Laboratory tests can help confirm the diagnosis.
Treatment
Pharmacological treatment
Lam et al suggested that cases of suspected severe influenza infection should be treated early and aggressively, even before diagnostic tests can be confirmed [8]. Commonly used antivirals include neuraminidase inhibitors like oseltamivir and zanamivir. M2 protein ion channel inhibitors, which are adamantine derivatives, like amantidine and rimantidine can also be used. Due to a marked increase in resistant isolates, the Advisory Committee on Immunization Practices (ACIP) recommends that adamantanes not be used in the United States for the treatment of influenza, except in selected circumstances [9].
Non-pharmacological treatment
It includes bed rest, the increased intake of fluids and a light but healthy diet during the flu. Typically, flu will resolve within a few days without any treatment.
Prognosis
Influenza has an excellent prognosis. Like all infectious diseases, it has a certain duration of action after which the symptoms begin to slowly subside. When there are no complications, acute symptoms subside within 3-7 days. Post-influenza asthenia may last for a few weeks.
The mortality associated with influenza is due to the complications associated with the disease. As a result of these complications, influenza can be deadly, especially for the weak, young and old, or chronically ill [6]. They include bacterial pneumonia, bronchitis, myositis, Reye syndrome in children, myocarditis and in some rare cases, multiorgan failure.
Etiology
Causative factors
There are 3 basic causative factors of this disease: Influenza A, B and C virus. They belong to the Orthomyxovirus family. Of the three, Influenza A virus is considered to be the most pathogenic and has at least 4 different recognized strains.
Transmission
Although the respiratory tract is presumed to be the primary site for the acquisition of infection, one study has suggested that transocular entry of influenza virus can occur [2]. Infection can be transmitted through sneezing and coughing and is thought to be transmitted primarily via large particle droplets (>5 microns) [3]. It is an airborne infection and close contact with a person with an active infection can transmit the disease.
Epidemiology
Incidence
According to a recent estimate by World Health Organization, 3 to 5 million cases of severe cases occur worldwide annually. 250,000 to 500,000 deaths have also been reported [4].
Age
Influenza affects young and old alike. Elderly patients with low immunity and immunocompromised individuals are particularly susceptible.
Sex
Influenza occurs equally in both sexes.
Pathophysiology
Influenza A is a genetically labile virus with mutation rates as high as 300 times that of other microbes [5]. It is known to cause pandemics worldwide. Influenza B is usually associated with smaller outbreaks. Influenza C has been reported to cause epidemics in children but mainly causes only mild respiratory infections.
After the virus has been inhaled, an incubation period of 12-24 hours ensues. A special substance present in the form of spikes on the virus is hemagglutinin. It binds to cell surface receptors to initiate infection. Another substance, neuroaminidase, present in the virus is an enzyme that degrades the protective layer of mucus in the respiratory tract. It also cleaves neuraminic acid to release progeny virus from the infected cells. It is the action of these two moieties that result in the symptoms of influenza as well as necrosis of the superficial layers of the respiratory epithelium.
Prevention
The main mode of prevention is the influenza vaccine that typically contains two strains of Influenza A virus and one strain of Influenza B virus. Annual influenza vaccination is an important public health measure for preventing influenza infection [10]. Currently, there are two types of vaccines available in the US. First is a killed vaccine containing purified protein subunits of the virus (hemagglutinin and neuraminidase). It has two versions, namely ‘split virus’ vaccine and ‘purified subunit’ vaccine. Both are administered intramuscularly. The second type is a live vaccine which contains temperature sensitive mutants of Influenza A and B virus.
Some antiviral drugs may also help in preventing the infection, particularly in elderly, non-vaccinated individuals.
Summary
Influenza is a common household occurrence. Commonly known as the ‘flu’, influenza is an infectious disease caused by a virus. Although it is often confused with other influenza-like illnesses, especially the common cold, influenza is a more severe disease [1]. It has been known to cause epidemics and pandemics worldwide. Influenza has a seasonal variation, being much more common in winter and in the rainy season. It has variations which pose to be a much bigger threat like the avian flu and the swine flu, however, our section deals with the general concept of this disease.
Patient Information
Definition
Influenza, simply called the flu, is a very common infectious disease of viral origin.
Cause
It is caused by Influenza virus A, B or C. Transmission is through airborne aerosol droplets that contain the infectious particles. It can be spread by close contact with a person having an active infection. Simple acts such as coughing, sneezing and even laughing can transmit the infection.
Signs and symptoms
Signs and symptoms include sudden high grade fever associated with chills, sore throat, runny nose and cough. Headache and body aches are commonly present. There may also be difficulty in breathing, increased heart rate, vomiting and diarrhea. Symptoms may go away on their own eventually within 3-7 days.
Diagnosis
Diagnosis is made based on clinical findings. Some laboratory tests may be performed to confirm the diagnosis. In case of complications such as pneumonia, a more through series of tests will be required.
Treatment
Treatment is not necessary as symptoms often resolve by themselves. Bed rest and fluids help speed up recovery. Some antiviral drugs may be used if needed along with painkillers to relieve headaches and muscle pain.
References
Article
- Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis 5 (11): 718–25, 2005.
- Bischoff WE, Reid T, Russell GB, Peters TR. Transocular entry of seasonal influenza-attenuated virus aerosols and the efficacy of n95 respirators, surgical masks, and eye protection in humans. J Infect Dis 2011; 204:193.
- Mubareka S, Lowen AC, Steel J, et al. Transmission of influenza virus via aerosols and fomites in the guinea pig model. J Infect Dis 2009; 199:858.
- Lozano R. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380 (9859): 2095–128, 2012
- Drake JW. Rates of spontaneous mutation among RNA viruses. Proc Natl Acad Sci U S A. May 1 1993;90(9):4171-5.
- Hilleman M. Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control. Vaccine. Aug 2002. 20 (25–26): 3068–87.
- Warren L. Review of Medical Microbiology and Immunology. 11th ed. Pa: McGraw Hill, 2010. ISBN 978-0-07-170028-3.
- Lam J, Nikhanj J, Ngab T, et al. Severe Cases of Pandemic H1N1 Pneumonia and Respiratory Failure Requiring Intensive Care. J Intensive Care Med. 5;26:318-25.
- Fiore AE, Fry A, Shay D, et al. Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
- Grohskopf LA, Olsen SJ, Sokolow LZ, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) -- United States, 2014-15 influenza season. MMWR Morb Mortal Wkly Rep 2014; 63:691.