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INFLUENZA

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DEFINITION- Acute respiratory viral infection with aerogenic transmission mechanism, antroponosis, characterized by lesions of the upper respiratory tract with the development of intoxication and catarrhal syndrome.Virus is pneumotropic belongs the family

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Слайд 1INFLUENZA

INFLUENZA

Слайд 2DEFINITION
- Acute respiratory viral infection with aerogenic transmission mechanism, antroponosis,

characterized by lesions of the upper respiratory tract with the

development of intoxication and catarrhal syndrome.

Virus is pneumotropic belongs the family Orthomyxoviridae;

- contains of RNA, nucleocapsid, lipoglycoprotein envelop;
has a rounded or oval shape;
nucleocapsid has S - antigen, H-antigen (hemagglutinin),
N-antigen (neuraminidase),

- has tropicity to the upper respiratory tract;
- resistant to low temperature;
- sensitive to heat, boiling, ultraviolet irradiation, disinfectants.

DEFINITION- Acute respiratory viral infection with aerogenic transmission mechanism, antroponosis, characterized by lesions of the upper respiratory

Слайд 3INFLUENZA: A SERIOUS THREAT
Influenza infection is associated with high morbidity,

significant economic costs and mortality!
5-10 %
5-10 %
adults and
20-30 %
children
Die from

complications:

250 – 500 th.

people

Economic costs:

1- 6 mln $ USA

on 100 000 population

According to WHO suffer from the influenza every year:

INFLUENZA: A SERIOUS THREATInfluenza infection is associated with high morbidity, significant economic costs and mortality!5-10 %5-10 %adults

Слайд 4 SUBTYPES OF INFLUENZA VIRUSES
INFLUENZA А
15 types of hemagglutinin (H1

- H15)
9 types of neuraminidase (N1 - N 9)
Viruses on

the difference of specific antigens of the nucleoprotein and matrix protein are divided into 3 types:
A, B and C.
Subtypes of influenza virus are isolated by antigenic variants of the surface glycoprotein
hemagglutinin (H) and neuraminidase (N)



Every change in the antigenic structure of surface glycoproteins causes the development of new pandemics and epidemics!

SUBTYPES OF INFLUENZA VIRUSESINFLUENZA А15 types of hemagglutinin (H1 - H15)9 types of neuraminidase (N1 -

Слайд 5INFLUENZA VIRUSES: A, B and C
PANDEMIA
frequent EPIDEMICS associated with high

morbidity and mortality
associated primarily with the virus
А
seldom
В
С
as a rule, is

asymptomatic and does not affect the incidence
INFLUENZA VIRUSES: A, B and CPANDEMIAfrequent EPIDEMICS associated with high morbidity and mortalityassociated primarily with the virusАseldomВСas

Слайд 6NATURAL RESERVOIRS OF INFLUENZA VIRUSES
Influenza А
Influenza В
Influenza С
birds, rare animals

only people
in humans, pigs, dogs

NATURAL RESERVOIRS OF INFLUENZA VIRUSESInfluenza АInfluenza ВInfluenza Сbirds, rare animals   only peoplein humans, pigs, dogs

Слайд 8SEASONAL prevalence of INFLUENZA
THE PEAK OF MORBIDITY
Outbreaks of influenza coincide

with the increase in the incidence of other ARVI!
Revealed a

clear dependence of the level of INFLUENZA morbidity of the population of the CITY:

> 1 MLN

FROM 500 TH TILL 1 MLN

LESS 500 TH

< 11,3 %

10,9 %

9,7 %

THE AUTUMN-WINTER PERIOD

THE BEST SURVIVAL OF VIRUS IN AEROSOLS AT LOW TEMPERATURE

A CROWDING OF PEOPLE IN ENCLOSED ROOMS

SEASONAL prevalence of INFLUENZATHE PEAK OF MORBIDITYOutbreaks of influenza coincide with the increase in the incidence of

Слайд 10RISK GROUPS FOR INFLUENZA
The INFLUENZA poses a serious DANGER primarily

to:
The INFLUENZA can occur without fever, with scanty pulmonary symptoms,

but with rapid, sometimes catastrophic, development of toxicity and complications, therefore, these portions of the population require special attention and control.

children first year of life

the elderly

persons with concomitant diseases of the heart, lungs, diabetes, other chronic diseases

RISK GROUPS FOR INFLUENZAThe INFLUENZA poses a serious DANGER primarily to:The INFLUENZA can occur without fever, with

Слайд 11INFLUENZA
The core of the virus contains single-stranded negative chain of

RNA consisting of 8 segments that encode 10 viral proteins
Fragments

of RNA have a general protein envelope, which unites them, forming a nucleoprotein

Nucleoprotein permanent in its structure and determines the virus type (A, B or C).

The surface antigens (H and N), in contrast, is variable and define different strains of the same type of virus.

INFLUENZAThe core of the virus contains single-stranded negative chain of RNA consisting of 8 segments that encode

Слайд 15The replication cycle of influenza virus
The replication cycle of influenza

virus in the human body lasts about 4 hours and

can be described as follows:

Hemagglutinin on the surface of the virus, binds to sialic acid on epithelial cells lining the respiratory tract.

1

The virus enters the epithelial cell by endocytosis and starts to multiply

2

The synthesis of new viral RNA and proteins, which are collected into viral particles occurs via the structures of the host cell

3

Viral particles are transported to the surface cells in the sheath which contains the hemagglutinin, neuraminidase and M2 channels.

4

Collecting of virions is completed, but they remain bound to cell surface via hemagglutinin and sialic acid.

5

The neuraminidase releases new viruses
which infect other cells

6

The replication cycle of influenza virusThe replication cycle of influenza virus in the human body lasts about

Слайд 16INFLUENZA : THE DEVELOPMENT OF THE PATHOLOGICAL PROCESS
epithelium of

the respiratory tract
«ENTRANCE GATE»
involvement of intact cells
replication of the virus

in the cells

structural changes, degradation, rejection of cells

Do not sneeze!

INFLUENZA : THE DEVELOPMENT OF THE PATHOLOGICAL PROCESS epithelium of the respiratory tract«ENTRANCE GATE»involvement of intact cellsreplication

Слайд 17INFECTION WITH INFLUENZA VIRUSES
From a sick person, who is the

source of the infection, the virus through coughing and sneezing

transmitted to healthy people by aerogenic mechanism through airborne, air–dust way
and by contact–household route

the replication cycle of 4-6 hours

isolation of virus from the respiratory tract

STARTS 1-2 days before onset of symptoms

ENDS after 5 –7days after the disappearance of clinical manifestations

INFECTION WITH INFLUENZA VIRUSESFrom a sick person, who is the source of the infection, the virus through

Слайд 18 CLINICAL PICTURE OF INFLUENZA INFECTION
The sudden rise of body

temperature (38-40°C);
Chills, dizziness, muscle pain, headache, weakness;
Rhinorrhea usually not observed,

patients often complain of a feeling of dryness in the nose and throat;
In some cases there is a dry, hard cough accompanied by pain behind the breastbone;

2 days
Incubation period

3-5 days
CLIMAX (febrile) period


The total duration of disease is 7-10 days

CLINICAL PICTURE OF INFLUENZA INFECTIONThe sudden rise of body temperature (38-40°C);Chills, dizziness, muscle pain, headache, weakness;Rhinorrhea

Слайд 19CLINICAL PERIODS OF INFLUENZA
1
2
3
4
5
PENETRATION
VIREMIA
LOCAL DEMIGE
BACTERIOLOGIC COMPLICATION
IMMUNIC
INCUBATION: ASIMPTOMATICAL
CLIMAX: DEVELOPMENT OF COMPLICATIONS
CLIMAX:

SPESIFIC SDs – CATARRHAL AND INTOXICATION
INITIAL: NONSPESIFIC SD – GENERAL

INTOXICATION

CONVALESCENCE: DISAPPEARANCE OF LIDING SDs;
ASTENOVEGETATIVE SD

CLINICAL PERIODS OF INFLUENZA12345PENETRATIONVIREMIALOCAL DEMIGEBACTERIOLOGIC COMPLICATIONIMMUNICINCUBATION: ASIMPTOMATICALCLIMAX: DEVELOPMENT OF COMPLICATIONSCLIMAX: SPESIFIC SDs – CATARRHAL AND INTOXICATIONINITIAL: NONSPESIFIC

Слайд 20CLINICAL CLASSIFICATION OF INFLUENZA
OBLITERATED
FULMINANT
SEVERE
COMPLICATED
INFLUENZA
TYPICAL FORM
ATYPICAL FORM

MILD
MODERATE
UNCOMPLICATED

CLINICAL CLASSIFICATION OF INFLUENZA OBLITERATEDFULMINANTSEVERECOMPLICATEDINFLUENZATYPICAL FORMATYPICAL FORMMILDMODERATEUNCOMPLICATED

Слайд 21SEVERITY OF INFLUENZA
MILD
MODERATE
SEVERE
increase of body temperature
in the range of

38.5–39°C,
moderate intoxication,
weakness, headache
Hypertoxic form occurs only in influenza, accompanied by

expressed hyperthermic, meningo - encephalitic and hemorrhagic syndrome !

body temperature can to remain
normal or not rise above 38°C,
the symptoms of intoxication
less expressed or absent

Increase of body temperature
up to 40-40,5°C,
dizziness, delirium,
seizures, hallucinations, vomiting

SEVERITY OF INFLUENZAMILDMODERATESEVERE increase of body temperaturein the range of 38.5–39°C,moderate intoxication,weakness, headacheHypertoxic form occurs only in

Слайд 24INFLUENZA : OUTCOMES OF VIRUS INTRODUCTION
LESIONS OF EPITHELIUM OF RESPIRATORY

TRACT
SUPPRESSION OF FUNCTION
of mucociliary clearance
macrophages
T - lymphocytes
INFLUENZA VIRUS
NEURAMINIDASE OF INFLUENZA

VIRUS

modifies cell surface glycoproteins

promotes the formation of new places for bacteria adhesion and the development of secondary purulent infection !

INFLUENZA : OUTCOMES OF VIRUS INTRODUCTIONLESIONS OF EPITHELIUM OF RESPIRATORY TRACTSUPPRESSION OF FUNCTIONof mucociliary clearancemacrophagesT - lymphocytesINFLUENZA

Слайд 25INTOXICATION at the INFLUENZA
From a place of primary localization of

the influenza virus gets into the blood, causing viremia that

resulted in severe intoxication.

Is characterized by:

increased permeability and fragility of blood vessels of different severity

- HEMORRHAGIC SYNDROME
- BLEEDING
HEMORRHAGES OF DIFFERENT
LOCALIZATION
Disturbance of MICROCIRCULATION
(until the development of DIC –
syndrome, infectious-toxic shock!)

SEVERE CASES:

In the development of the neurotoxic syndrome in influenza plays an important role disorder of cerebral hemodynamics and cerebral edema!

Intoxication at the influenza

INTOXICATION at the INFLUENZAFrom a place of primary localization of the influenza virus gets into the blood,

Слайд 26Complications of the INFLUENZA
THE MOST COMMON:
PNEUMONIA
ACUTE BRONCHITIS
BRONCHIOLITIS
Influenza infection leads

to EXACERBATION:
chronic bronchitis/
chronic obstructive
pulmonary

disease;
bronchial asthma;
mucoviscidosis;

PNEUMONIA DEVELOPS:

5-38% with influenza A

10 % with influenza B

Distinguish
- primary viral pneumonia
(developed as a result of direct viral infection of the lungs) and
- secondary bacterial pneumonia (bacterial superinfection can complicate the course of primary viral pneumonia, and or to be independent late complication of the flu).

Complications of the INFLUENZATHE MOST COMMON: PNEUMONIAACUTE BRONCHITISBRONCHIOLITISInfluenza infection leads to EXACERBATION: chronic bronchitis/  chronic obstructive

Слайд 28Mortality from influenza and its complications takes the first place

among all infectious diseases!
5-10 %
80 - 90 %
of patients older

than 65 years in the structure of mortality from the flu

6 %

of deaths due to influenza in adults, young patients without apparent risk factors!

1/3

complications associated with influenza occur among people, healthy in all other indicators

Most cases of influenza in hospitalized patients are younger than 65 years

INFLUENZA : THE RISK OF COMPLICATIONS

Mortality from influenza and its complications takes the first place among all infectious diseases!5-10 %80 - 90

Слайд 29ETIOLOGICAL DIAGNOSIS OF INFLUENZA
METHODS:
Etiologic diagnosis for most patients
in clinical practice

is not possible (!),
due to technical difficulties, the complexity and

relative high cost of virological and immunological methods.

During epidemics of influenza the performance of clinical diagnosis is high and reaches 70%!

the method of direct immunofluorescence
polymerase chain reaction – PCR
reaction of complement binding
enzyme-linked immunosorbent assay
virological method

ETIOLOGICAL DIAGNOSIS OF INFLUENZAMETHODS:Etiologic diagnosis for most patientsin clinical practice is not possible (!),due to technical difficulties,

Слайд 30 DIFFERENTIAL DIAGNOSIS of colds and influenza
Non-specific diagnosis of

influenza:
GBC: leukopenia, shift to the left formula, increased ESR;
urinalysis:

leukocyturia, proteinuria, microhematuria,
cylindruria;
biochemical blood: the increase of urea, creatinine;
coagulogramm changes in severe forms;

DIFFERENTIAL DIAGNOSIS of colds and influenzaNon-specific diagnosis of influenza:GBC: leukopenia, shift to the left formula,

Слайд 31DIFFERENTIAL DIAGNOSIS of colds and influenza

DIFFERENTIAL DIAGNOSIS of colds and influenza

Слайд 32DIFFERENTIAL DIAGNOSIS of colds and influenza

DIFFERENTIAL DIAGNOSIS of colds and influenza

Слайд 33DIFFERENTIAL DIAGNOSIS of colds and influenza

DIFFERENTIAL DIAGNOSIS of colds and influenza

Слайд 34ways of influence the infectious process
IMMUNOCORRECTIVE THERAPY
PATHOGENETIC THERAPY
SYMPTOMATIC THERAPY
LEADING ROLE
have

a direct effect
on the reproduction of the virus
and some
virus-specific target

in its cycle

1st generation – amantadine and rimantadine
2 generation – zanamivir and oseltamivir

ETIOTROPIC DRUGS

SPECIFIC TREATMENT

ways of influence the infectious processIMMUNOCORRECTIVE THERAPYPATHOGENETIC THERAPYSYMPTOMATIC THERAPYLEADING ROLEhave a direct effecton the reproduction of the

Слайд 35RIMANTADINE
Limitation:
MECHANISM of ACTION: inhibition of the synthesis of M-protein of

influenza virus, disrupts the process of reproduction and formation of

complete virions.

rapid development of resistance in viruses (resistance);
narrow spectrum of activity (only influenza A);
common side effects;



SPECIFIC TREATMENT

RIMANTADINELimitation:MECHANISM of ACTION: inhibition of the synthesis of M-protein of influenza virus, disrupts the process of reproduction

Слайд 36one of the main enzymes involved in replication of
influenza viruses

A and B.
Violates penetration of the virus into healthy cells
inhibites

further spread of the virus in the body

THE ATTACK ON NEURAMINIDASE

INHIBITION

Reduces production of proinflammatory cytokines;
Prevents development of local inflammatory reaction;
Attenuates systemic symptoms of influenza (fever, myalgia);


SPECIFIC TREATMENT

one of the main enzymes involved in replication ofinfluenza viruses A and B.Violates penetration of the virus

Слайд 37mechanism of action of neuraminidase inhibitors
Primary
infection
Replication
viruses
Blockade of
neuraminidase
Violation of viral
replication and


distribution

the sooner the better



mechanism of action of neuraminidase inhibitorsPrimaryinfectionReplicationvirusesBlockade ofneuraminidaseViolation of viralreplication and distributionNАthe sooner the betterNАNАNА

Слайд 38OSELTAMIVIR
Selective inhibitor of neuraminidase;
Inhibits the release of formed

virus;
It is used to treat influenza A and B;

It is used to prevent influenza A or B in people
who had contact with patients

NEUROAMINIDASE

OSELTAMIVIR

SPECIFIC TREATMENT

OSELTAMIVIR Selective inhibitor of neuraminidase; Inhibits the release of formed virus; It is used to treat influenza

Слайд 39TREATMENT
(Patients with mild forms can be treated ambulatory, with severe

forms- should be hospitalized)
1. Bed rest;
2. Diet № 15, drink

plenty of liquids;

3. Etiotropic treatment:
- anti-influenza gamma-globulin (3ml) - i/m in the first 3 days,
- interferon 2-3 drops every 1-2 h for 3 days,
- rimantadine – 1-st day: 0,1 g × 3 t/d,
2-nd day and 3-rd day: 0,1 g × 2 t/d;
- oseltamivir – 0,75 g × 2 t/d (5 days);
- zanamivir - 1 inhalation × 2 t/d

4. Pathogenic therapy: - desintoxication; - desensitization;
- angioprotectors; - metabolites;

5. Symptomatic treatment: antipyretics, vitamins, local antiseptics;
6. Antitussive drugs, mucolytics, vasoconstrictor nasal drops;
7. Antibiotics - in complications, exacerbation of chronic diseases
TREATMENT(Patients with mild forms can be treated ambulatory, with severe forms- should be hospitalized)1. Bed rest;2. Diet

Слайд 40DIFFERENTIAL DIAGNOSIS of ARVI

DIFFERENTIAL DIAGNOSIS of ARVI

Слайд 41DIFFERENTIAL DIAGNOSIS of ARVI

DIFFERENTIAL DIAGNOSIS of ARVI

Слайд 42DIFFERENTIAL DIAGNOSIS of ARVI

DIFFERENTIAL DIAGNOSIS of ARVI

Слайд 43DIFFERENTIAL DIAGNOSIS of ARVI

DIFFERENTIAL DIAGNOSIS of ARVI

Слайд 45
Strict adherence to sanitary-hygienic regime in the epidemic

and pre-epidemic period, regular general wet cleaning, bactericidal air

disinfection.

2. The use of personal protective equipment (disposable masks).

3. Specific prevention (vaccination). Routine immunization can be
carried out throughout the year, but the greatest its effectiveness
in the autumn before the influenza season.

4. Nonspecific prevention of influenza
and ARVI aimed at increasing the general
resistance of the human body:
- improvement of immune status with
immunomodulators;
- promotion of healthy lifestyle, tempering;
- creation of favourable temperature in the room;

PROFILAXIS OF INFLUENZA

Strict adherence to sanitary-hygienic regime in the epidemic    and pre-epidemic period, regular general wet

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