Influenza Pathophysiology 2012 (1)

Virus is introduced into the respiratory tract 2

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Virus is introduced into the respiratory tract 2. Attachment to sialic receptors on pulmonary epithelial cells ( hemagglutinin ) 3. Membrane fusion, endocytosis and viral entry 4. Uncoating of the virus ( M2 protein ) 5. RNA transcripts travel to the nucleus; new RNA transcripts and proteins ( H and N ) are produced 6. Assembly and packaging of new viral particles and release of newly replicated virus ( neuraminidase ) 7. Infection of adjacent pulmonary epithelial cells Establishment of Infection
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2. Attachment to sialic acid receptors on epithelial cells ( H ) 1. Virus is introduced into the respiratory tract Pathogenesis of Infection Establishment of Infection Neuraminidase Sialic acid receptor Hemagglutinin M2 protein
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2. Attachment to sialic acid receptors on epithelial cells ( H ) 3. Fusion and endocytosis 4. M2 protein uncoats the virus releasing genetic material ( M2 ) RNA transcripts (genes) travel to the nucleus and are replicated 5. New proteins and RNA transcripts are produced and assembled 1. Virus is introduced into the respiratory tract Nucleus 6. Packaging of new viral particles and release of newly replicated virus ( N )
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6. Packaging of new viral particles and release of newly replicated virus ( N ) Pathogenesis of Infection Establishment of Infection Hemagglutinin remains bound to sialic acid receptors Neuraminidase enzyme cleaves sialic acid and allows for viral release
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Questions ???
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Key Steps in the Evaluation and Management of Influenza 1. Consider clinical presentation 1. Evaluate diagnostic tests and lab values 3. Consider antiviral therapy 4. Provide appropriate monitoring of therapeutic interventions
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Key Steps for Evaluating Pneumonia Consider Clinical Presentation “Classic” signs and symptoms: Abrupt onset of fever (100.0 F – 104.0 F) Chills (at times shaking) Headache and myalgias Sore throat Non-productive cough +/- eye irritation and rhinorrhea Chest x-ray Bilateral findings are common (in contrast to focal findings with bacterial pneumonia)
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Month of Peak Influenza Activity United States, 1976-2005 Percent of Influenza Cases
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Dec Feb Oct May
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Dec Feb May Jul
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Key Steps for Evaluating Pneumonia Viral culture Highly reliable test; results in 3-10 days Reverse transcription PCR Detection of viral RNA Highly reliable test: results in 2-4 hours Has become gold standard testing method Rapid antigen testing Detection of viral antigens Less reliable than PCR and culture (false negatives) Results in < 1 hour (POC testing) Diagnostic Testing and Laboratory Data **Nasopharyngeal specimens (swab/nasal wash) preferred over throat swab
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Key Steps for Evaluating Pneumonia Nasopharyngeal Swab Collection Insert swab into one nostril straight back (not upwards) Continue for several cm’s
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