INFLUENZA COMPLICATIONS. Influenza complications Bacterial superinfections – bacterial pneumonia...
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Transcript of INFLUENZA COMPLICATIONS. Influenza complications Bacterial superinfections – bacterial pneumonia...
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.
• 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
Influenza – respiratory complications
*5–10% of pneumonia is an influenza complication
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
Groups at higher risk of complications
• Elderly (> 60 years of age), especially in residential care units• Children and 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.
0
20
40
60
80
0–4 5–9 10–19 20–39 40–49 50–59 50–69 > 70
Age groups (year)
Res
pir
ato
ry
com
pli
cati
on
s (%
)
Age distribution of respiratory complications
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.
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.
Severe symptoms in children
30%
Bronchiolar, pulmonary signs
40%
Vomiting, diarrhoea
50%
Pharyngitis
90%
Fever, rhinitis
Kilbourne ED. Influenza. New York: Plenum Medical Book Company; 1987: 157–66.
• Retrospective cohort study, Tennessee Medicaid program (1973–1993)• Children under 15 with medically treated asthma or chronic medical conditions
Age group Excess hospitalisation
per 1000
Under 1 year 19
1 to < 3 years 8
3 to < 15 years 2
Yearly excess hospitalisation for cardiopulmonary disease due to influenza in
different age group per 1000 high risk children
•Influenza morbidity is high in this class of patient,and often underestimated
Other yearly consequencesof influenza
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
Neuzil KM et al. J Pediatr 2000; 137: 856–64.
Influenza in pregnancy
• Severe pulmonary complications and death for pregnant woman
• Foetal loss and abortion• Other risks
– foetal complications (growth, weight, etc.)– brain damage– neural tube defects
Possible consequences:
Vulnerability during the second and third trimester
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.
Pneumonia and influenza associated death
870Associated cardiovascular and pulmonary disease
481Associated cardiovasculardisease and diabetes
104Cardiovascular disease
2Healthy adults
240Pulmonary disease
Barker WH et al. Arch Intern Med 1982; 142: 85–9.
By courtesy of APACIAsia-Pacific Advisory Committee on influenzawww.apaci-flu.com