Diagnosis and management of swine flu
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Transcript of Diagnosis and management of swine flu
DIAGNOSIS AND MANAGEMENT OF SWINE FLU
A MOHAMED KASIM
TOPICS TO BE DISCUSSED:
• DIAGNOSTIC TESTS FOR SWINE FLU.
• INDICATIONS FOR TREATMENT.
• PRIMARY AND ALTERNATIVE REGIMENS .
• ANTI-VIRAL PROPHYLAXIS AND VACCINATION.
DIAGNOSTIC TESTS FOR SWINE 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.
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.
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
ANTIVIRALS USED IN SWINE 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.
PRIMARY REGIMENS FOR ADULTS:
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.
SUPPORTIVE CARE:1- IV fluids.
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.
PREVENTION OF SWINE FLU:• 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.
ANTI-VIRAL PROPHYLAXIS Prophylaxis should be 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.
DOSE REGIMENS FOR PROPHYLAXIS:
1- Oseltamavir 75mg once daily for 10 days.
2- Zanamavir inhaled powder – 10mg once daily for 10days.
VACCINATION• 1- H1N1 vaccine 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
THANK YOU.