1 TASHKENT MEDICAL ACADEMY Department of infectious and pediatric infectious diseases Acute viral respiratory infections and influenza Reader: Candidate of Medical Science, associate professor, Niyazova T.A.

2 Counsel: 1. Introduction – 5 min. 2. Historical data – 5 min. 3Counsel: 1. Introduction – 5 min. 2. Historical data – 5 min. 3. Etiology and epidemiology – 10 min. 4. Pathogenesis and pathological anatomy – 10 min. 5. Clinical findings – 30 min. 6. Diagnosis – 8 min. 7. Treatment measures – 10 min. 8. Preventive measures – 7 min. 9. Conclusion – 5 min.

3 Acute viral respiratory infections (AVRI) and influenzaК ним относятся грипп, парагрипп, аденовирусные, респираторно-синцитиальные, риновирусные, энтеровирусные, коронавирусные заболевания.

4 INFLUENZA Influenza, commonly referred to as the flu or grippe, is an acute, highly contagious infection of the respiratory tract, results from three different types of Myxovirus influenzae.

5 ETIOLOGY Pathogenic organism (agent) - RNA virus of the family Orthomyxoviridae, size of virus – nm; In virus classification influenza viruses are RNA viruses that make up three of the five genera of the family Orthomyxoviridae: Influenzavirus A, B, C; The type A viruses are the most virulent human pathogens and genetic changeable among the three influenza types; Changeability of virus is showed by changing of superficial antigens: - hemagglutinin (Н); - neuraminidase (N).

6 Viruses of influenza

7 Этиология

8 Epidemiology Large epidemics of influenza A arise in the range from 2 to 3 years, pandemics arise in the range from 10 to 15 years; Type B also strikes annually but causes epidemics only every 4 to 6 years; Type C is endemic and causes only sporadic cases; Source of infection is sick person, particularly at the height of the disease (4-7 days of illness); Transmission of influenza occurs through of a respiratory droplet from an infected person or by indirect contact, such as the use of a contaminated drinking glass; Although influenza affects all age-groups, its incidence is highest in schoolchildren.

9 Known flu pandemics NAME OF PANDEMIC DATE DEATHS CASE FATALITY RATESUBTYPE INVOLVED Asiatic (Russian) Flu 1889–1890 1 million 0.15% possibly H3N8 1918 flu pandemic (Spanish flu) 1918–1920 20 to 100 million 2% H1N1 Asian Flu 1957–1958 1 to 1.5 million 0.13% H2N2 Hong Kong Flu 1968–1969 0.75 to 1 million <0.1% H3N2 2009 flu pandemic 2009–2010 18,000 0.03%

11 Epidemiology

12 Pathogenesis (by Kethiladze Е.S.) :Reproduction of viruses in epithelial cells of mucous membrane of respiratory tract; Virusemia, toxic and toxic-allergic reaction of organism; Causing inflammation and desquamation; Bacterial complications of respiratory tract and other organs; Decrease of pathological process and change-over to recovery.

13 Pathogenesis

14 Classification of influenza (S.D.Nosov,1972)Typical: 1. with complications: 1) easy form 2) средней тяжести 3) тяжелой 2. without complications: 1) легкой Atypical: 1. Afebrile influenza (без осложнением, с осложнением) 2. Acatarrhal influenza (без осложнением, с осложнением ) 3. Flash-like influenza: а) протекающие с геморрагичеким пневмонией. б) протекающие без геморрагичеким пневмонией.

15 Symptoms of influenza Symptoms of influenza can start quite suddenly one to two days after infection; Usually the first symptoms are chills or a chilly sensation, but fever is also common early in the infection, with body temperatures ranging from °C; Many people are so ill that they are confined to bed for several days, with aches and pains throughout their bodies, which are worse in their backs and legs.

16 Symptoms of influenza may include:Fever and extreme coldness (chills shivering, shaking (rigor)); Cough, nasal congestion; Body aches, especially joints and throat; Fatigue, headache; Irritated, watering eyes; Reddened eyes, skin (especially face), mouth, throat and nose; In children, gastrointestinal symptoms such as diarrhea and abdominal pain.

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18 Clinical findings

19 Clinical findings

23 Fibrinogenous- necrotic laryngotracheo-bronchitis

24 Segmental inflammation

25 COMPLICATIONS Pneumonia;Rhinitis, pharyngitis, laryngitis, tracheobronchitis, locular and ва follicular quinsy, antritis, frontal sinusitis, ethmoiditis, otitis and others; Meningitides, meningo-encephalitis, arachnoiditis, polyneuritis, radiculitis.

26 DIAGNOSTICS Clinical findings; Viral investigations;Serologic investigations (RTGA, Reiter's complement fixation test, (R)CFT, RNGA); Immune-enzyme analysis.

27 DIFFERENTIAL DIAGNOSTICSEpidemic spotted fever, Brill's [Brill-Zinsser] disease; Typhoid (enteric) fever and paratyphoid А , В; Meningococcal infectious; Tuberculosis meningitis; Aseptic [serous] meningitis; Tick-borne [vernal] encephalitis; Poliomyelitis; Infectious mononucleosis; Hepatitis А; Brucellosis; Q-fever; Ornithosis; Measles; Scarlet fever; Malaria.

28 TREATMENT Regimen; Diet; Etiological treatment;Pathogenetic treatment; Symptomatic treatment.

29 ETIOLOGICAL TREATMENTThe two classes of antiviral drugs used against influenza are neuraminidase inhibitors and M2 protein inhibitors: Neuraminidase inhibitors – oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza); M2 inhibitors (adamantanes) - amantadine and rimantadine.

30 PROPHYLAXIS Isolation of sick (patient);Separate all plates and dishes used by sick (patient); Во время эпидемии гриппа запретить частое собрание многих людей в помещение; All people must wear gauze mask; Specific preventive measures (vaccination) should be carry out at the beginning of epidemic.

31 PROPHYLAXIS Type of influenza vaccine

32 Thank you for your attention!