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INFLUENZA COMPLICATIONS

INFLUENZA COMPLICATIONS. Influenza complications. Bacterial superinfections bacterial pneumonia croup respiratory disorders Decompensation of chronic diseases pulmonary disease heart disease renal insufficiency metabolic disease. Nicholson KG. Semin Respir Infect 1992; 7: 26 – 37.

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INFLUENZA COMPLICATIONS

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  1. INFLUENZA COMPLICATIONS

  2. Influenza complications • Bacterial superinfections • bacterial pneumonia • croup • respiratory disorders • Decompensation of chronic diseases • pulmonary disease • heart disease • renal insufficiency • metabolic disease Nicholson KG. Semin Respir Infect 1992; 7: 26–37.

  3. Influenza – respiratory complications • Upper respiratory tract infection (URTI) • otitis media • sinusitis • Lower respiratory tract infection (LRTI) • exacerbation of asthma/chronic obstructive pulmonary disease (COPD) • croup, bronchiolitis • primary viral pneumonia (rare*) • secondary bacterial pneumonia *5–10% of pneumonia is an influenza complication

  4. Influenza complications • Primary viral pneumonia • Bacterial secondary pneumonia • Tracheobronchitis • Bronchiolitis • Congestive heart failure • Myocarditis, pericarditis • Complications of sinus, middle ear, musculature • Reye’s syndrome – in children • Ketoacidosis – in diabetics • Acute viral encephalitis – in children • Guillain Barre syndrome • Gastrointestinal bleeding – in children • Decompensation of pre-existing pathology • Excess mortality • Possible association with prenatal exposure and schizophrenia

  5. Groups at higher risk of complications • Elderly (> 60 years of age), especially in residential care units • Childrenand teenagers (6 months–18 years of age) receiving long-term aspirin therapy • Pregnant women belonging to high-risk groups • Patients with: • chronic respiratory disease, e.g. asthma, COPD • chronic heart disease • chronic metabolic disease, e.g. diabetes mellitus • immunosuppression due to treatment or disease, e.g. HIV • haematological disorders • chronic renal failure Palache AM. Influenza subunit vaccine - ten years experience. Eur J Clin Res 1992; 3: 117–38.

  6. Age distribution of respiratory complications 80 60 Respiratory complications (%) 40 20 0 0–4 5–9 10–19 20–39 40–49 50–59 50–69 > 70 Age groups (year) Betts FR et al. In: Mandell GL et al., eds. Principles and Practice of Infectious Diseases.3rd Edn. New York: Churchill Livingstone; 1990: 1306–25.

  7. Influenza complicationsin children • Higher fever than in adults • Higher incidence of coryza, otitis media and gastrointestinal manifestations • Influenza may present as croup or bronchiolitis • Higher incidence of drowsiness and delirium • Complications like myositis and pneumonia are more frequent Nicholson KG. Semin Respir Infect 1992; 7: 26–37.

  8. Bronchiolar, pulmonary signs 30% Vomiting, diarrhoea 40% Pharyngitis 50% Fever, rhinitis 90% Severe symptoms in children Kilbourne ED. Influenza. New York: Plenum Medical Book Company; 1987: 157–66.

  9. Influenza in children with asthma and other chronic medical conditions • Outpatients visits • 120 to 200 per 1000 at-risk children • Antibiotic courses • 65 to 140 per 1000 at-risk children • Retrospective cohort study, Tennessee Medicaid program (1973–1993) • Children under 15 with medically treated asthma or chronic medical conditions Yearly excess hospitalisation for cardiopulmonary disease due to influenza in different age group per 1000 high risk children Other yearly consequencesof influenza Age group Excess hospitalisation per 1000 Under 1 year 19 1 to < 3 years 8 3 to < 15 years 2 • Influenza morbidity is high in this class of patient,and often underestimated Neuzil KM et al. J Pediatr 2000; 137: 856–64.

  10. Severe pulmonary complications and death for pregnant woman Foetal loss and abortion Other risks foetal complications (growth, weight, etc.) brain damage neural tube defects Influenza in pregnancy Vulnerabilityduring the second and third trimester Possibleconsequences: Anonymous. Lancet 1994; 343: 665; Lynberg MC et al. Am J Epidemiol 1994; 140: 244–55; Takei N et al. Eur Arch Psychiatry Clin Neurosci 1995; 245: 255–9; Wright P et al. Am J Psychiatry 1995; 152: 1714–20.

  11. Associated cardiovascular and pulmonary disease 870 Associated cardiovasculardisease and diabetes 481 240 Pulmonary disease Cardiovascular disease 104 Healthy adults 2 Pneumonia and influenza associated death Barker WH et al. Arch Intern Med 1982; 142: 85–9.

  12. By courtesy of APACIAsia-Pacific Advisory Committee on influenzawww.apaci-flu.com

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