IDSA Clinical Practice Guideline for Acute Bacterial Rhino Sinusitis in Children and Adults
Common cold,rhino sinusitis,influenza
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Transcript of Common cold,rhino sinusitis,influenza
Common Cold , Rhino sinusitis,Influenza
Dr. Shahid PervaizDr. Shahid Pervaiz
Postgraduate Registrar Postgraduate Registrar
Pulmonology Department Pulmonology Department
Nishtar Hospital MultanNishtar Hospital Multan
Definition: the common cold
benign self-limited syndrome
caused by members of several families of viruses
Mild upper respiratory viral illness
Symptoms: the common cold
Day 1 : sore or “scratchy” throat, +/- low grade fever
Day 2-3 : nasal obstruction, rhinorrhea, sneezing.
Thick purulent nasal discharge does NOT mean bacterial sinusitis!
Day 4-5: cough becomes bothersome, nasal symptoms less severe
• Average duration: 3-7 days
• Virus-induced changes in airway reactivity can persist for up to 4 weeks
Symptoms: the common cold*Day 1
Symptoms: the common cold*Day 2 to 3
Symptoms: the common cold*Day 4 to 5
• thick purulent nasal discharge does NOT mean bacterial sinusitis!
50%
15%
15%
5%5% 10% Rhinovirus
Coronavirus
Influenza
RSV
Parainfluenza
Adeno, Entero
Virology *4,5
Seasonal Patterns
Fall, late spring : Rhinovirus Parainfluenza
Winter, spring: RSV, coronavirus
Summer: Enterovirus (year)
Adenovirus: Outbreaks in Military facilities daycare centers, hospital
Facts: the common cold
• Incubation period 24 to 72 hours• Average duration 3 – 7 days•Virus-induced changes in airway reactivity can persist for up to 4 weeks(Rhinovirus )• 2 to 3 episodes /per year*
Diferential diagnosis: the common cold
•Allergic or seasonal rhinitis •Bacterial pharyngitis or tonsillitis •Sinusitis •Influenza
But how do I know it’s just a cold?
COLD INFLUENZA
Fever Rare 39-40o
Headache Rare Usual
Myalgia Mild Severe
Malaise Mild May last 3 wks
Extreme fatigue Unusual Usual
Nasal congestion Common Common
Sneezing Common Sometimes
Sore throat Common Common
Chest discomfort/ cough
Mild Mod-Severe
Facts: Influenza
•Patients with illnesses which involve the cardiovascular or pulmonary systems •Patients with diabetes mellitus, renal disease, hemoglobinopathy, or immunosuppression.
•Residents of nursing homes or chronic care facilities
•Otherwise healthy individuals over age 50
Facts: Influenza Vaccine
All of the mentionated before Plus
Health care workers
Pregnant women in second or third trimestrer
But how do I know it’s just a cold?
• Acute Bacterial Sinusitis
• complicate 0.5-2% of colds
• Diagnosis = persistent URTI with no improvement >10-14 days OR worsening after 5 days +
• nasal congestion/ purulent nasal discharge
AND
• facial pain
But how do I know it’s just a cold?
• Pneumonia =
1. 2 of: fever, new cough, pleuritic chest pain, SOB +
2. Auscultatory findings +
3. New opacity on CXR
•Asthma
Airway reactivity
Vs
Acute asthma attacks exacerbationsUp to 40% of viral upper resp infection
Complications
Sinusitis: Acute bacterial sinusitis develops in 0.5 to
2.5 percent of adult patients after viral *1
Lower respiratory tract disease :
RSV, elderly (CHF) and immunocompromised
Acute otitis media: Eustachian tube dysfunction;
.
FACTS: transmission*
• Hand –to- hand
• most efficient = direct contact
• virus can survive for 2 hours on human skin
• also aerosol
• NOT via saliva
(in 90% of people with colds, no detectable virus in saliva)
FACTS: the common cold
• You can be re-infected by the same virus, but subsequent illness will be milder and shorter
• NO evidence that cold climate increases susceptibility to respiratory illness
Treatment: the common cold
• the ONLY “A” recommendation is NOT to use antibiotics to treat the common cold.
• everything else is “B” (inconsistent or limited quality evidence)
Treatment: what might work
COUGH:
• dextromethorphan (DM) – cough suppressant
• Cochrane review: 2 studies: benefit, 1 study: no benefit
• guaifenesin (Benylin E, Robitussin) – expectorant
•1 study: benefit, 1 study: no benefit
Treatment: what might work
NASAL CONGESTION:
• topical or oral decongestant (pseudoephedrine = Sudafed)
• small benefit of single dose, NO benefit of repeated use over several days
• topical intranasal Atrovent (0.06% spray)
• 2x 42ug sprays per nostril TID-QID x 4 days
• decreased nasal discharge by 26% : only 1 study, expensive
• humidified air and fluid intake
• inconsistent results, but no harm!
Treatment: what WON’T work
COUGH:
• codeine – works for chronic cough, NOT for acute cough
• antihistamines – no benefit
Treatment: what WON’T work
NASAL CONGESTION:
• Antihistamines *1
• no benefit, significant adverse effects
• Saline nasal spray
• no benefit
Treatment: the common cold
COMPLEMENTARY/ ALTERNATIVE:
• Vitamin C
• no effect if started after onset of symptoms
• inconsistent results if started before: may slightly decrease cold duration if 200mg daily
• Exercise
• decreased incidence in overweight postmenopausal women who exercised 5x/week
Treatment: the common cold
COMPLEMENTARY/ ALTERNATIVE:
• Echinacea
• no evidence in well-designed studies
• Zinc
• inhibits viral growth in vitro
• inconsistent study results
QUIZ: the common cold
What is the most common culprit?
a. rotavirus
b. coronavirus
c. rhinovirus
d. echovirus
e. influenza virus
QUIZ: the common cold
What is the most common culprit?
a. rotavirus
b. coronavirus
c. rhinovirus
d. echovirus
e. influenza virus
QUIZ: the common cold
Patient wants to spend his money on treatments that he can be sure will help his symptoms. What do you suggest?
a. Antibiotics
b. Antihistamine
c. Codeine
d. Dextromethorphan
e. Pseudoephedrine
f. D. or E.
g. None of the above – just rest and fluids
QUIZ: the common cold
a. Antibiotics
b. Antihistamine
c. Codeine
d. Dextromethorphan
e. Pseudoephedrine
f. D. or E.
g. None of the above – just rest and fluids
RHINO-SINUSITISRHINO-SINUSITIS
SINUSITIS AND ITS MANAGEMENT
Anatomy of sinuses
• Where are the Where are the sinuses? sinuses?
• Four pairs of Four pairs of paranasal sinuses paranasal sinuses • Frontal-above eyes in Frontal-above eyes in
forehead boneforehead bone• Maxillary-in Maxillary-in
cheekbones, under eyescheekbones, under eyes• Ethmoid-between eyes Ethmoid-between eyes
and noseand nose• Sphenoid-in center of Sphenoid-in center of
skull, behind nose and skull, behind nose and eyeseyes
EMBRYOLOGICAL DEVELOPMENT
• The sinuses are hollow air-filled The sinuses are hollow air-filled sacs lined by mucous membrane. sacs lined by mucous membrane.
• The ethmoid and maxillary The ethmoid and maxillary sinuses are present at birth. sinuses are present at birth.
• The frontal sinus develops during The frontal sinus develops during the 2the 2ndnd year and the sphenoid year and the sphenoid sinus develops during the 3sinus develops during the 3rdrd year year
EMBRYOLOGICAL DEVELOPMENT
• At birth, the ethmoid, sphenoid At birth, the ethmoid, sphenoid and maxillary sinuses are tiny and and maxillary sinuses are tiny and cause problems in infants and cause problems in infants and toddlers.toddlers.
• Frontal sinuses develop between 4-Frontal sinuses develop between 4-7 years of age, causing problems in 7 years of age, causing problems in school aged children and school aged children and adolescents.adolescents.
Inflammation of paranasal sinuses
INFLAMED SINUSES
DEFINATION AND INCIDENCE• An acute inflammatory process An acute inflammatory process
involving one or more of the involving one or more of the paranasal sinuses. paranasal sinuses.
• A complication of 5%-10% of URIs in A complication of 5%-10% of URIs in children.children.
• Persistence of URI symptoms >10 Persistence of URI symptoms >10 days without improvement. days without improvement.
• Maxillary and ethmoid sinuses are Maxillary and ethmoid sinuses are most frequently involvedmost frequently involved
PATHOGENESIS:
• Usually follows rhinitis, which may be viral or Usually follows rhinitis, which may be viral or allergic.allergic.
• May also result from abrupt pressure changes (air May also result from abrupt pressure changes (air planes, diving) or dental extractions or infections. planes, diving) or dental extractions or infections.
• Inflammation and edema of mucous membranes Inflammation and edema of mucous membranes lining the sinuses cause obstruction.lining the sinuses cause obstruction.
• This provides for an opportunistic bacterial This provides for an opportunistic bacterial invasioninvasion
PATHOGENESIS:
• With inflammation, the mucosal lining of With inflammation, the mucosal lining of the sinuses produce mucoid drainage. the sinuses produce mucoid drainage. Bacteria invade and pus accumulates Bacteria invade and pus accumulates inside the sinus cavities. inside the sinus cavities.
• Postnasal drainage causes obstruction of Postnasal drainage causes obstruction of nasal passages and an inflamed throat. nasal passages and an inflamed throat.
• If the sinus orifices are blocked by swollen If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the mucosal lining, the pus cannot enter the nose and builds up pressure inside the nose and builds up pressure inside the sinus cavities.sinus cavities.
PREDISPOSING FACTORS
• Allergies, nasal deformities, cystic Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection.fibrosis, nasal polyps, and HIV infection.
• Cold weatherCold weather
• High pollen countsHigh pollen counts
• Day care attendanceDay care attendance
• Smoking in the homeSmoking in the home
• Re-infection from siblingsRe-infection from siblings
AETIOLOGY
• 70% of bacterial sinusitis is caused by:70% of bacterial sinusitis is caused by:• Streptococcus pneumoniaeStreptococcus pneumoniae• Haemophilus influenzaeHaemophilus influenzae• Moraxella catarrhalisMoraxella catarrhalis
• Other causative organisms are:Other causative organisms are:• Staphylococcus aureusStaphylococcus aureus• Streptococcus pyogenes,Streptococcus pyogenes,• Gram-negative bacilliGram-negative bacilli• Respiratory virusesRespiratory viruses
SYMPTOMS:
• History of URI or allergic rhinitisHistory of URI or allergic rhinitis• History of pressure changeHistory of pressure change• Pressure, pain, or tenderness over Pressure, pain, or tenderness over
sinusessinuses• Increased pain in the morning, Increased pain in the morning,
subsiding in the afternoonsubsiding in the afternoon• MalaiseMalaise• Low-grade temperatureLow-grade temperature
SYMPTOMS:
• Persistent nasal discharge, often Persistent nasal discharge, often purulentpurulent
• Postnasal dripPostnasal drip• Cough, worsens at nightCough, worsens at night• Mouthing breathing, snoringMouthing breathing, snoring• History of previous episodes of History of previous episodes of
sinusitissinusitis• Sore throat, bad breathSore throat, bad breath• HeadacheHeadache
CLINICAL FEATURES:
• Periorbital edemaPeriorbital edema• CellulitisCellulitis• Nasal mucosa is reddened or swollenNasal mucosa is reddened or swollen• Percussion or palpation tenderness over a Percussion or palpation tenderness over a
sinussinus• Nasal discharge, thick, sometimes yellow Nasal discharge, thick, sometimes yellow
or greenor green• Postnasal discharge in posterior pharynxPostnasal discharge in posterior pharynx• Difficult trans-illuminationDifficult trans-illumination• Swelling of turbinatesSwelling of turbinates• Boggy pale turbinatesBoggy pale turbinates
DIAGNOSTIC TESTS:
• Imaging studies, such as sinus Imaging studies, such as sinus radiographs, ultrasonograms, or CT radiographs, ultrasonograms, or CT scanning – indicated if child is scanning – indicated if child is unresponsive to 48 hours of unresponsive to 48 hours of antibiotics and if the child has a toxic antibiotics and if the child has a toxic appearance, chronic or recurrent appearance, chronic or recurrent sinusitis, and chronic asthma. sinusitis, and chronic asthma.
• Laboratory studies, such as culture of Laboratory studies, such as culture of sinus puncture aspirates.sinus puncture aspirates.
DIFFERENTIAL DIAGNOSIS
• septum deviation)septum deviation)• Nasal foreign body Allergic rhinitisNasal foreign body Allergic rhinitis• Non-allergic rhinitisNon-allergic rhinitis• Infectious rhinitisInfectious rhinitis• Drug-induced rhinitisDrug-induced rhinitis• Nasal polypsNasal polyps• Dental abscessDental abscess• Carcinoma of sinusCarcinoma of sinus• Cluster headacheCluster headache• Structural defectsStructural defects
MEDICAL TREATMENT
• Acetaminophen or ibuprofen to relieve Acetaminophen or ibuprofen to relieve painpain
• DecongestantsDecongestants
• AntihistaminesAntihistamines
• Nasal salineNasal saline
ANTIBIOTIC TREATMENT:
• Antimicrobials-treat for 10-14 days, Antimicrobials-treat for 10-14 days, depending upon severity, with one of depending upon severity, with one of the following:the following:
• Amoxicillin:20-40mg/kg/d in 3 Amoxicillin:20-40mg/kg/d in 3 divided doses(>20kg, 250mg tid)divided doses(>20kg, 250mg tid)
• CLAVUNATED AMOXICILLIN:CLAVUNATED AMOXICILLIN:25-25-50mg/kg/d in 2 divided doses, 50mg/kg/d in 2 divided doses, Use Use suspension if child is less than 40kg.suspension if child is less than 40kg.
TREATMENT
• SEPTRAN: CO-SEPTRAN: CO-TRIMOXAZOLE+TRIMETHOTRIMOXAZOLE+TRIMETHOPRIMPRIM
• CEFACLOR:500MG:1 *TDSCEFACLOR:500MG:1 *TDS
• STEAM INHALATIONSTEAM INHALATION
FOLLOW UP INSTRUCTIONS
Humidifier to relieve the drying of Humidifier to relieve the drying of mucous membranes associated with mucous membranes associated with mouth breathingmouth breathing
• Increase oral fluid intakeIncrease oral fluid intake
• Saline irrigation of the nostrilsSaline irrigation of the nostrils
• Moist heat over affected sinusMoist heat over affected sinus
• Prolonged shower to help promote Prolonged shower to help promote drainagedrainage
PATIENT EDUCATION:
• Child should not dive.Child should not dive.• Child should not travel by airplane.Child should not travel by airplane.• Urge parent to eliminate triggers in the home Urge parent to eliminate triggers in the home
(dust, smoking)(dust, smoking)• Have all members of the family treated, if Have all members of the family treated, if
indicated. indicated. • Instruct parent to call in 48 hours if condition of Instruct parent to call in 48 hours if condition of
child has not improved.child has not improved.• Instruct parent to bring child in for a recheck in Instruct parent to bring child in for a recheck in
2 weeks.2 weeks.
ALLERGIC RHINITIS
ALLERGIC RHINITIS
Def. of Rhinitis: Is an inflammation of the nasal mucous membranes.
However, with allergic rhinitis, other organs or tissues are involved, such as eyes, ears, sinuses, oropharinx.
ALLERGIC RHINITIS
•-Is an Immunologic Hypersensitivity Disorder Type I
•-Is often a predisposing factor or exacerbation of asthma, rhinosinusitis, nasal polyps.
•-Characterized by one or more nasal Sx- sneezing, itching, congestion, rhinorrhea.
•-Diagnosis is based on Hx, physical findings, and Lab.
Impact of Allergic Rhinitis
•Most common form of atopic disease
•Affects 40 million Americans
•Prevalence estimates: 10/30% of adults, 40% of children
•Peak incidence in childhood and adolescence
•Almost 70% of the patients have nasal congestion
•Nearly 17 million office visits a year
Impact of Allergic Rhinitis
•Direct costs per year of about 6 billion dollars
•Increase absenteeism and reduced productivity
•75/80% of patients with asthma have allergic rhinitis.
Genetics:
High incidence in families with atopic disease (eczema, asthma)
Classification:
Seasonal: Yearly intervals, periodic symptoms, often due: to outdoor allergens-pollens, tree pollens (spring), grass (summer), ragweed (mid August). Mold spores
Classification:
Perennial: Throughout the entire year, due to multiple seasonal allergies or continue exposure to: indoors allergen: Dust mite (Dermatophagoides), animal dander, cigarette smoke, hair ,spray, paint, mold, cockroaches outdoor allergens: Pollens, tree pollens (spring), grass (summer), ragweed (mid August).Mold spores
PATHOPHYSIOLOGY
Allergens bind to specific IgE on Mast cells in Respiratory mucosa Enzymatic reactions occurs within the cell Release of mediators (histamine, leukotrienes, prostaglandins) from mast cells triggering IgE, leads to a complex interaction of inflammatory mediators, causing inflammation of the mucous membranes of eyes, nose, Eustachian tube, sinuses and/or pharinx.
There are 2 phases of allergic response:Early phase response to antigen: < 5- 30 minutes after allergen exposure.-Allergen comes in contact with IgE-primed mast cells and basophils-Caused by the immediate release of histamine and other mediators (leukotrienes). -Causing bronchoconstriction, edema, and stimulation of mucous gland that leads to: Production of secretions: Increase in vascular permeability leads to plasma exsudation Vasodilation leads to nasal congestion and sinus pressure
Late phase response to antigen: 2-12 hours after allergen exposureCharacterized by sx beginning 4-8 hours after allergic exposure. This phase occurs because of inflammation resulting from the recruitment of inflammatory cells (Cytotoxic proteins released by neutrophils, eosinophils, macrophages, lymphocytes – damaging the Epithelial cells) to the mucous membranes.This phase has more congestion, rhinorrhea and less sneeze/itching.
S/S: Seasonal: Clear and watery drainage from nose (rhinorrhea) tearing of the eyes and red eyes frequent sneezing Lesser mouth breather Itching of their nose, eyes, palate / throat (erythema can be seen) eczema, family Hx. of atopy support the Dx. of allergic rhinitis.
Perennial: Year round symptoms, nasal congestion (major complaint) post-nasal drainage (dry cough)
mouth breather decreased sense of smell/or taste.
Other SX: ↓ in physical functioning, energy and fatigue, social events, ↑ in pain and limitations of emotions, ↓ quality of life
“allergic shiners” Dark circles under the eyes (Moonshiners). Chronic venous stasis from sinus congestion“Dennie-Morgan”: single or double lines under the eyes due to chronic edema.Allergic salute: Rubbing of the tip of the nose upward to ↓ itching
Allergic crease: Transverse line near the tip of the nose, secondary to rubbingNasal mucosa: Pale color, edema of turbinates (inferior), clear watery secretion, colored mucus secretion Nasal polyps: Gray color, peeled-grape appearance, insensitivity to touch
Upper Respiratory Infection-Common ColdEtiology: Rhinoviruses, Parainfluenza, RSV, Adenovirus
Risk factors: Day care, smoking, crowding, temperature changes
Upper Respiratory Infection-Common Cold
S/S: Nasal/throat irritation
Sneezing, nasal congestion, rhinorrhea
Sore throat, postnasal drip
Low grade fever, HA, malaise, myalgia
Can lead to AOM, Sinusitis, asthma
TX: Fluids, supportive
INFECTIOUS RHINITIS
Most common cause of nasal symptoms in children is viral URI. Specially in day care/kindergarten/winter months
Last between 7-14 days, symptoms resolving around the 7th/8th dayFever may or may not appear
INFECTIOUS RHINITIS
Clear mucus discharge, changing to green/yellow after a few days, Cough post nasal drip
Turbinates can be swollen and erythematous. Secretions are watery or thick, clear or colored.
Complicated by sinusitis or obstruction by adenoidal hypertrophy
TX: ATB (purulent mucus), mucolitics, cough syrup
LAB:
CBC- Eosinophilia
Nasal cytology- Eosinophilia. Greater than 10% is (+)
Skin testing- Prick/puncture in skin 10-20 allergens. Immediate hypersensitivity with immediate results. There is a small chance of triggering a severe allergic reaction in someone highly allergic.
LAB:
RAST– Radio Allergo Absorbent Test: Measure allergen- specific IgE, measure specific IgE to individual allergen in a sample of blood. Is less sensitive than skin testing.
Total IgE: Elevated in allergic rhinitis
TX:Environmental control: Avoidance of specific allergens.1-Outdoor allergents: Pollens/outdoor molds: limit outdoor activity during allergy season Keep windows and doors closed Wear a mask while doing yard work.
2-Indoors: Use dust mite anti-allergic pillow and mattress plastic covers Reduce indoor heat and humidity decreasing proliferation of mites Eliminate carpeting, and use linoleum, tiles. Avoid feathers in pillows and covers. Molds: Eliminate areas of dampness and standing water Clean mold area Pets : Avoid as much as possible or don’t have them Use HEPA filters and A/C Eliminate cockroaches
Nasal Steroids: Effective for itching, sneezing, rhinorrhea,
nasal congestion
More effective than oral antihistamine.
Budesonide (Rhinocort), flonase, nasonex
Antihistamine: Block H1 receptors suppressing most of symptoms
First generation: H1 antagonist with anticholinergic effects (sedating, dry mouth, tachycardia)
Effective for most Sx. of allergic rhinitis, but on congestion is limited.
Benadryl (dyphenhydramine)
Second generation:
H1 antagonist with no/less anticholinergic sedating effect.
Effective for most symptoms, improved but not efficient on congestion.
Zyrtec (cetirizine), Clarinex (desloratidine)
Singulair (montelukast-Leukotrienes blockers)
Topical cromolyn sodium (Nasalcrom-Intal): Mast cell stabilizer Used above 6 years of age
Oral decongestants: alpha-1-adrenergic agonists: phenylephrine, phenylpropalamine.- SudafedCause vasoconstriction, ↓ blood supply to nasal mucosa / edemaTopical decongestants: Sympathomimetics. Side effects-drying and burning of the mucosa. Using more than 5 days- rebound vasodilation and congestion. Oxymetazoline -Afrin
Combined oral decongestant and antihistamines: Extendryl / Rondec- chlorpheniramine
Mucolytics: Thin mucus, improving mucociliary flow. Steam, NS drops, Guaifenesin, N-acetylcysteine
Immunotherapy: Given to patients that not responded to drug therapy and good environmental control
POS
ALLERGIC RHINITIS
INFLUENZA
Define influenza
Influenza commonly called Influenza commonly called “the flu” is a highly contagious “the flu” is a highly contagious infection of the nose, throat, infection of the nose, throat, bronchial tubes, and lungs.bronchial tubes, and lungs.
Infective agent
• Influenza is caused by viruses that infect the Influenza is caused by viruses that infect the respiratory tract.respiratory tract.
• Two main types:-Two main types:-1.Influenza type-A1.Influenza type-A2.Influenza type-B2.Influenza type-B• These viruses can under go two types of These viruses can under go two types of
changes.changes.• ““Antigenic drift” – gradual evaluation of Antigenic drift” – gradual evaluation of
virus.virus.• ““Antigenic Shift” _ occurs only occasionally.Antigenic Shift” _ occurs only occasionally.
How do people get influenza
• Influenza occurs world wide. The Influenza occurs world wide. The major types of influenza virus live major types of influenza virus live and change inside animals, and change inside animals, primarily birds, pigs, and horses.primarily birds, pigs, and horses.
• It spreads through the Air, most It spreads through the Air, most often when an infected person often when an infected person sneezes, cough, or speaks.sneezes, cough, or speaks.
Signs and symptoms
• Abrupt feverAbrupt fever• Muscle achesMuscle aches• Severe tirednessSevere tiredness• CoughCough• Sore throatSore throat• Runny or stuffy noseRunny or stuffy nose• HeadacheHeadache These symptoms typically appear 1-5 These symptoms typically appear 1-5
days after infection.days after infection.
How is influenza diagnosed
• Health care provider will Health care provider will diagnose influenza based on diagnose influenza based on typical symptoms of fever, typical symptoms of fever, chills, headache, cough and chills, headache, cough and body aches.body aches.
Who is at risk for influenzaAny one can get. but the risk of complication in Any one can get. but the risk of complication in
highest in these groups.highest in these groups.1.Person aged 65 years and older1.Person aged 65 years and older2.Residents of nursing home2.Residents of nursing home3.Adults and children with long lasting disorders of 3.Adults and children with long lasting disorders of
the lungs or heart.the lungs or heart.4.Adults and children with diabetes, kidney disease, or 4.Adults and children with diabetes, kidney disease, or
weakened immune systemsweakened immune systems5.Health-care workers, house hold members and 5.Health-care workers, house hold members and
others who are contact with persons at high risk for others who are contact with persons at high risk for influenza. influenza.
Treatment for influenza
• There is no cure for influenza.There is no cure for influenza.
• Rest and liquids are main treatment.Rest and liquids are main treatment.
• Antiviral drug- Tamiflu is licensed for Antiviral drug- Tamiflu is licensed for treatment of both the main types of treatment of both the main types of influenza in humans (type A and type B) influenza in humans (type A and type B) it may prevent or reduce the severity of it may prevent or reduce the severity of influenza.influenza.