hanan ibrahim fatal flu
TRANSCRIPT
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A 6 years old previously healthy boy with
extensive pneumonia.
Rapidly progressing ARDS.
CRP and CBC shows no signs of bacterial
sepsis.
Leucopenia, lymphopenia.
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Bacterial Pneumonia:CRP-ve
CBC parametersNo response to aggressive
antibiotic therapy
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Atypical PneumoniaThe "atypical" bacteria are Coxiella burnetti,
Chlamydophila pneumoniae , Mycoplasma pneumoniae ,
and Legionella pneumophila.
They are "atypical" because they commonly affect
teenagers and young adults, are less severe, and require
different antibiotics than typical bacteria such as
Streptococcus pneumoniae.
http://en.wikipedia.org/wiki/Atypical_pneumoniahttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Atypical_pneumoniahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Legionella_pneumophilahttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Mycoplasma_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Chlamydophila_pneumoniaehttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Coxiella_burnettihttp://en.wikipedia.org/wiki/Atypical_pneumonia -
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Viral PneumoniaFlu preceding pneumonia
V. raped course
CBC parameters
No response to antibiotics
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Viruses that commonly cause pneumonia include:
Influenza virus A and B(Avian Flu, Swine Flu)
Respiratory syncytial virus (RSV)
Adenoviruses (in military recruits)
Metapneumovirus
Human parainfluenza viruses (in children)Corona Virus (SARS)
Hanta Virus
Rhino Virus
Viruses that rarely cause pneumonia include:
Herpes simplex virus (HSV), mainly in newbornsVaricella-zoster virus (VZV)
Cytomegalovirus (CMV), mainly in people with immune system
problems
http://en.wikipedia.org/wiki/Influenza_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Influenza_virushttp://en.wikipedia.org/wiki/Cytomegalovirushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Varicella-zoster_virushttp://en.wikipedia.org/wiki/Herpes_simplex_virushttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Human_parainfluenza_viruseshttp://en.wikipedia.org/wiki/Metapneumovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Human_respiratory_syncytial_virushttp://en.wikipedia.org/wiki/Influenza_virus -
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Viruses account for the largest proportion ofchildhood pneumonia; viruses decrease in
frequency as the etiology of pneumonia in healthy
adults, and once again become frequent causes of
death and morbidity in persons older than 60
years.
Viral pneumonia can vary from a mild illness to a
life-threatening disease with respiratory failure,severe hypoxemia, and ARDS.
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Viruses associated with severepneumonia and ARDS
-Influenza Virus-Corona Virus(SARS)
-Adeno Virus-Metapneumovirus
-Hanta Virus
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Human MetapneumovirusHMNV,a respiratory virus identified in 2001, is
emerging as one of the most common causes of
serious lower respiratory tract illness in children
allover the world.
It belongs to Paramyxoviridae family.
HMNV outbreaks in annual epidemics (late winterand early spring ).
C.P. is similar to the profile of RSV.
Young age is a major risk of severe illness.
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AdenovirusAdenoviruses are medium-sized (90-100 nm),nonenveloped icosohedral viruses containing double-
stranded DNA.
There are 51 immunologically distinct types (6subgenera: A through F) that can cause human
infections.
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Clinical Syndromes by Adenoviruses
-Acute Respiratory DiseasePharyngitis
Pneumonia
pertussis-like syndome
pharyngoconjunctival fever
-Conjunctivitis and keratoconjunctivitis(Pink Eye Syndrome)
-Myocarditis
-Gastrointestinal Infections
-Hemorrhagic cystitis
-Reye Syndrome and Reye-like Syndrome
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Severe Pneumonia andARDS
are most often associated withadenovirus types 3, 7,and 21 .
Such infections have highmortality, and residual airway
damage.
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Killer Cold Virus: Adenovirus Infection (Ad14)
A rare strain of a cold virus, known as adenovirus type 14
(Ad14), has caused severe and even fatal respiratory
illness in healthy children and adults.
Infection with the virus seems to be becoming morecommon in the United States, according to officials from
the U.S. Centers for Disease Control and Prevention
(CDC).
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This virus is different from other adenoviruses that cause
the common cold in that it may produce an unusuallysevere illness requiring intensive medical care.
Although the Ad14 strain was identified in the 1950s, the
variant that was isolated in 2006 and 2007 is genetically
different from the original Ad14, suggesting that the viralgenetic material has undergone mutations (changes)
that have resulted in the increased severity of infections
with Ad14.
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Severe acute respiratorysyndrome
SARSis a respiratory disease in humans which is caused by theSARS coronavirus (SARS-CoV).There has been one near pandemicto date, between the months of November 2002 and July 2003,
with 8,096 known infected cases and 774 deaths (a case-fatality
rate of 9.6%) worldwide being listed in the World Health
Organization's (WHO) 21 April 2004 concluding report.
Within a matter of weeks in early 2003, SARS spread from the
Guangdong province ofChina to rapidly infect individuals in some
37 countries around the world.
http://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Respiratory_diseasehttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Guangdonghttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/SARS_coronavirushttp://en.wikipedia.org/wiki/Humanhttp://en.wikipedia.org/wiki/Respiratory_disease -
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As of May 2006, the spread of SARS has been
fully contained thanks to the efforts of the WHO,with the last infected human case seen in June
2003 (disregarding a laboratory induced infection
case in 2004).However, SARS is not claimed to have been
eradicated (unlike smallpox), as it may still be
present in its natural host reservoirs (animalpopulations) and may potentially return into the
human population in the future.
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Influenza Viruses
Influenza, commonly referred to as the flu, is an
infectious disease caused by RNA viruses of the family
Orthomyxoviridae(the influenza viruses), that affects
birds and mammals.Types of Influenza virus:
Influenza virus A
Influenza virus B
Influenza virus CIsavirus
Thogotovirus
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Antigenic drift
Antigenic drift is due to mutation. Antibodies to the HA proteinare the most important in protection, although those to NA also
play a role. Both proteins undergo antigenic drift (i.e. accumulate
mutations) and accumulate changes such that an individual
immune to the original strain is not immune to the drifted one.
Antigenic drift results in sporadic outbreaks and limited
epidemics.
Antigenic shift
Antigenic shift is due to reassortment. In the case of influenza
A, antigenic shift periodically occurs. Apparently "new" HAand/or NA are found in the circulating viral strains. There is little
immunity (particularly if both proteins change, or if new HA is
present) and an epidemic/pandemic is seen.
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H1N1, which caused Spanish flu in 1918, and Swine flu in2009
H2N2, which caused Asian Flu in 1957
H3N2, which caused Hong Kong Flu in 1968
H5N1, a pandemic threat in the 2007
08 flu seasonH7N7, which has unusual zoonotic potential
H1N2, endemic in humans and pigs
H9N2
H7N2H7N3
H10N7
http://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/H10N7http://en.wikipedia.org/wiki/H7N3http://en.wikipedia.org/wiki/H7N2http://en.wikipedia.org/wiki/H9N2http://en.wikipedia.org/wiki/H1N2http://en.wikipedia.org/wiki/Zoonotichttp://en.wikipedia.org/wiki/H7N7http://en.wikipedia.org/wiki/Pandemichttp://en.wikipedia.org/wiki/H5N1http://en.wikipedia.org/wiki/Hong_Kong_Fluhttp://en.wikipedia.org/wiki/H3N2http://en.wikipedia.org/wiki/Asian_Fluhttp://en.wikipedia.org/wiki/H2N2http://en.wikipedia.org/wiki/Swine_fluhttp://en.wikipedia.org/wiki/Spanish_fluhttp://en.wikipedia.org/wiki/H1N1 -
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105
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Avian FluHuman influenza pandemics over the last 100 years havebeen caused by H1, H2,and H3 subtypes of influenza A
viruses.
More recently, avian influenza viruses havebeen found to directly infect humans from their avian
hosts.
The recent emergence, host expansion, and spread of a
highly pathogenic avian influenza (HPAI) H5N1subtype in Asia has heightened concerns globally, both in
regards to mortality ofHPAI H5N1 in humans and the
potential of a new pandemic
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Since the first H5N1 outbreak occurred in 1997, there
has been an increasing number ofHPAI H5N1 bird-to-
human transmissions leading to clinically severe and
fatal human infections.
Although millions of birds have become infected withthe virus since its discovery, 248 humans have died from
the H5N1 in twelve countries according to WHO data as
of January 2009.
Epidemiologists are afraid that the next time such a virusmutates, it could pass from human to human. If this
form of transmission occurs, another pandemic could
result.
http://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHO -
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The clinical manifestations of avian influenza in humans have
ranged from mild conjunctivitis to severe pneumonia with
multiple organ failure (MOF)
The main presenting symptom is pneumonia with fever and an
influenza-like illness. Diarrhea was present in upto 70% of thecases.
Many cases had both thrombocytopenia and lymphopenia.
Chest radiographic findings included interstitial infiltrates, lobar
consolidation, and air bronchograms.
Sixty-eight percent of patients developed ARDS and MOF within
6 days of disease onset.
The average time of death from disease onset was 910 days.
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DiagnosisThe clinical diagnosis of avian influenza
infection in humans is difficult and relies
on the epidemiological link to endemicareas, contact with sick or dead poultry, or
contact with a confirmed case of avian
influenza.Polymerase Chain Reaction (PCR)
on clinical samples with primers specific for
the viral subtype.
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TreatmentAntiviral therapy, Supportive
care, and Adjunctive therapies
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Antiviral TherapyThe adamantanes (rimantadine and amantadine) Adamantanes bindto the M2 protein on the viral capsule, HPAI H5N1 isolated from
Southeast Asia carriedthe mutation in M2 that conferred resistance to
this group of antivirals
Neuraminidase inhibitors (oseltamivir and zanamivir) The timing oftreatment is paramount, as earlier therapy is directly related to
improved survival. The greatest level of protection was seen if the
neuraminidase inhibitors were started within 48 hours of infection,
and protection rapidly dropped after 60 hours.
For oseltamavir, therapy has been at75 mg twice daily, with 75 mgonce daily reserved for prophylaxis.
Zanamivir is available in a dry powder inhalation at 10 mg twice daily
for treatment and 10 mg daily for prophylaxis.
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Vaccination
Not yet available
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Infection Control and
Preventative MeasuresWorld Health Organization (WHO) and Centers for Disease Control
and Prevention (CDC) recommend contact and airborne
precautions for any initial suspected case of avian influenza in ahuman.
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-Use ofmasks and respirators in the health care setting
In certain high risk procedures,additional protection with
an N-95 particulate respirator may be considered .
-Impermeable gown, face shield, and gloves.
-Initial cases should be placed in a negative pressure
isolation room with 6-12 air changes per hour.
-Hand hygiene with antibacterial soap or alcoholbased
washless gel should be standard, with appropriate basins
at each patient room.
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Infection control measures are the mainstay for
prevention and disease reduction. Avian influenza
viruses may constitute part of the
next pandemic, so appropriate knowledge,
prevention, and treatment will reduce the
likelihood of this occurrence.
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Thank you