Diagnosis and management of Swine Flu

Diagnosis and management of Swine Flu

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  DIAGNOSIS AND MANAGEMENTOF SWINE FLU A MOHAMED KASIM
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  TOPICS TO BEDISCUSSED: • DIAGNOSTIC TESTS FOR SWINE FLU. • INDICATIONS FOR TREATMENT. • PRIMARY AND ALTERNATIVE REGIMENS . • ANTI-VIRAL PROPHYLAXIS AND VACCINATION.
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  DIAGNOSTIC TESTS FORSWINE FLU: • NON SPECIFIC FINDINGS: 1- COMPLETE HEMOGRAM: Leucopenia, thrombocytopenia and anemia. 2- LIVER FUNCTION TEST:- Raised liver enzymes and elevated bilirubin. 3- OTHERS: Increased CPK and LDH. 4- X-RAY: Bilateral infiltrates(lower lobe predominance). 5- CT CHEST: Patchy consolidation or ground glass opacities.
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  SPECIFIC FINDINGS: 1- RT-PCR:Highly sensitive and very high specific. Usually recommended for clinical diagnosis faster turnaround time. Specimens usually taken from nasopharyngeal swab or throat swab, sometimes tracheal aspirates in intubated patients. 2- VIRAL CULTURE: Moderately sensitive and has highest specificity, usually recommended for public health surveillance and not useful in clinical situations due to long turnaround time. 3- RAPID ANTIGEN TEST: Not recommended nowadays.
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  INDICATIONS FOR TREATMENT: 1-ILLNESS REQUIRING HOSPITALISATION. 2- PROGRESSIVE, SEVERE OR COMPLICATED ILLNESS, REGARDLESS OF PREVIOUS HEALTH STATUS. 3- EXTREMES OF AGE. 4- PREGNANT WOMEN AND WOMEN UPTO TWO WEEKS OF POSTPARTUM. 5- INDIVIDUALS WITH HIGH RISK MEDICAL CONDITIONS AND THOSE WHO ARE OBESE
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  ANTIVIRALS USED INSWINE FLU: Common anti-viral agents used to treat are neuraminidase inhibitors and M-protein inhibitors. 1- Oseltamavir and Zanamavir – Neuraminidase inhibitors. 2- Amantadine and Rimantadine- M-protein inhibitors.
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  PRIMARY REGIMENS FORADULTS: 1- Oseltamavir 75mg BD for 5days. 2- Zanamavir 2 inhalations of 5mg each for 5days. ALTERNATIVE AND NEWER REGIMENS: 1-Peramavir 600mg IV single dose – longer duration, may be considered for severe disease. 2- Zanamavir 600mg IV BD for 5days in patient not tolerating oral oseltamavir or suspected/confirmed cases of oseltamavir resistance.
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  SUPPORTIVE CARE: 1- IVfluids. 2- Anti-pyretics. 3- Oxygen support for hypoxic patients. 4- Low tidal volume ventilation for mechanically ventilated patients. 5- Patients with Pandemic H1N1 can develop pneumonia and should be treated for Community acquired pneumonia. 6- Adjunctive approaches have been evaluated including ECMO, NAC and glucocorticoids.
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  PREVENTION OF SWINEFLU: • 1- Face masks- N-95 or triple layered surgical mask. • 2- Frequent hand wash. • 3- Adherence to cough etiquettes by the patient. • 4- Contact surfaces should be disinfected with sodium hypochlorite or household bleach (5%). • 5- Adult patients should be isolated until their symptoms subside. • 6- In children the isolation period is little longer due to prolonged excretion of viruses.
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  ANTI-VIRAL PROPHYLAXIS Prophylaxis shouldbe considered for adults and children who had close contact with a confirmed or suspected cases. 1- Adults who are at high risk for complications of influenza. 2- Pregnant women and women who are up to two weeks post- partum. 3- Children who are less than 5yrs of age or who are at high risk for complication for influenza. 4- Healthcare workers and emergency medical personnel.
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  DOSE REGIMENS FORPROPHYLAXIS: 1- Oseltamavir 75mg once daily for 10 days. 2- Zanamavir inhaled powder – 10mg once daily for 10days.
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  VACCINATION • 1- H1N1vaccine should be given to all patients from six month of age or older. • 2- Priority should be health-care personnel. • 3- Available Vaccines are IIV, LAIV, RIV. The most common used is the IIV. • 4- The selection of vaccine subunits is based on the strain prevalence in the previous year. Efficacy is 70-80%. • 5- It takes 2 to 3 weeks for the immunity to develop. • 6- Risks of GBS, narcolepsy, transverse myelitis have been reported
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  THANK YOU.