PMM II – Influenza, Guillian-Barre Syndrome, Viral and Fungal Pneumonia, Histoplasmosis & Coccidioidomycosis

*how is influenza transmitted?*
*respiratory droplets, cough, sneeze, touching articles without washing hands, etc*

*when are adults and peds contagious with influenza*?
*adults = one day before symptoms present*;
*peds = shed virus up to six days before illness*

what are some symptoms for influenza?
abrupt onset of symptoms;
fever/chills (100-104);
sore throat (often severe x 3-5 days);
myalgia (common and severe);
H/A (frontal or retro-orbital);
rhinitis;
cough (non productive, pleuritic CP, dyspnea) and weakness

what are PE findings for influenza?
auscultation = WNL initially, but later = active cough, wheezing, diffuse rales, and possible decreased breath sounds;
fever (100-104);
tachycardia (d/t hypoxia and fever);
(*febrile and fatigue with hot, moist, flushed face and red, watery eyes, erythematous pharynx and rhinorrhea*)

*what are dx test for influenza?*
*RT-PCR* = gold standard;
*nasopharyngeal swabs for viral culture*;
*rapid diagnostic tests for influenza* (high specificity but moderate sensitivity)

what is prognosis for influenza?
most patients = 3 day recovery;
malaise may persist for weeks

what is tx for influenza?
supportive care;
no abx;
analgesic prn for HA and fever (tylenol prn);
increased fluid intake;
O2 prn

what are 4 antivirals for influenza that can be used as prophylaxis (must use within 48 hours)?
amantidine; rimantidine; oseltamivir (Tamiflu); zanamivir

*what are the neuraminadase inhibitors approved for the tx and prevention of influenza?*
oseltamivir; zanamivir

what is the single most important way to prevent transmission of influenza?
handwashing;

how long after influenza vaccine administration does immunity develop?
14 days

what is the most common complication for influenza?
pneumonia

*What is Guillan-Barre Syndrome*
*an autoimmune disorder where the body produces antibodies that damage the myelin sheath surrounding peripheral nerves leading ascending paralysis*

*what are classic presentations for GBS?*
*acute*;
*inflammatory*;
*demyelinating polyneuropathy*

what nerves undergo demyelination with GBS?
peripheral nerves and spinal roots (but also cranial nerves)

*what are chacteristic symptoms or presentation for GBS?*
*progressive, symmetric ascending muscle weakness*;
*paralysis*;
*hyporeflexia*

*what are motor signs and symptoms for GBS?*
*symmetric limb weakness beginning in the proximal LE and ascending to UE, trunk muscles and head*

*what are PE findings for GBS*
*proximal muscle weakness* (eval = have patient rise from sitting position without using arms);
*foot drop* (d/t decreased dorsiflexion strength);
*shoulder weakness with intact grip strength*;
*lack of DTRs*

*what is a hallmark sign for GBS?*
*lack of DTRs*

what are some sensory signs for GBS?
paresthesia (toes and fingertips moving upward);
loss of vibration, proprioception, touch, and distal pain;
pain (shoulder girdle, back, buttocks, thighs)

*what are precipitating events for GBS?*
*viral* (viral GI infx, flu, common cold, viral hepatitis, infectious mono)

patient epidemiology for GBS
all groups; M=F

*what are dx tests for GBS?*
*lumbar puncture*;
*EMG/NCS*

*what is a characteristic finding on lumbar puncture for GBS?*
*elevated protein*

what does EMG detect for GBS?
loss of reflexes

what does NCS detect?
record the speed at which signals travel along nerve fibers

*what are the 4 main viruses responsible for viral pneumonia in children and immunocompromised patients?*
*influenza virus*;
*respiratory syncytial virus (RSV)*;
*adenovirus*;
*parainfluenza virus (PIV)*

*what is the most common cause of viral pneumonia (what virus)?*
*influenza virus types A & B*

what are symptoms of influenza pneumonia?
persistent symptoms of cough;
sore throat;
headache;
myalgia;
malaise

*what virus causes the most lower respiratory tract infections in infants and children*
*RSV*
(second most common cause of viral pneumo in adults)

what are symptoms of RSV pneumonia?
fever;
nonproductive cough;
otalgia;
anorexia;
dyspnea

what are common PE findings for RSV pneumonia?
wheezes;
rales;
rhonchi

what are signs and symptoms of parainfluenza pneumonia?
fever;
cough;
coryza;
dyspnea with rales and wheezing

what are lab tests for viral pneumonia?
cytologic evaluation;
viral culture;
rapid antigen detection;
PCR;
serology

*what test gives definite diagnosis for viral pneumonia?*
*serologic testing*

*what are radiologic findings for viral pneumonia?*
*bilateral lung involvement, but no pathognomonic findings for any type of virus*

what are risk factors for fungal pneumonia?
exposure to fungal spores (geographical predilection)

who are at risk for fungal pneumonia?
immunocompromised patients (acute leukemia or lymphoma; bone marrow or transplant pts; prolonged steroid therapy; AIDS)

what are some symptoms of viral pneumonia?
fever; cough (nonproductive); pleuritic CP chest discomfort; obstructive symptoms; hx of travel to or exposure in endemic areas with mycoses

*what is the cause of pulmonary histoplasmosis?*
*inhalation of histoplasma, which is a soil fungus*

what are some endemic locations for histoplasmosis?
parts of North and Central America, with most cases in the *Ohio and Mississippi River valley* (d/t moderate climate, humidity, and soil characteristics)

*what patients are susceptible to histoplasmosis?*
*men aged older than 50 years with chronic lung disease (e.g COPD)*;
*immunosuppressed patients*

*what are some causes and risk factors for histoplasmosis?*
*exposure during activities that disturb soil harboring the organism, generating aerosols of spores*

what is intervention for pulmonary histoplasmosis?
antifungal treatment if symptoms last for more than 4 weeks; mild = no tx

*what is the cause of coccidioidomycosis aka Valley Fever*?
*coccidioide fungus found in the soil of dry, low rainfall areas*

*what areas are endemic to coccidioidomycosis*?
*southwestern US such as Arizona and California*;
*Mexico, Central and South America*

*what patients are more susceptible for coccidioidomycosis*?
*immunocompromised patients*

when do symptoms of coccidioidomycosis occur?
1 and 3 weeks after inhaling the fungal spores

what are symptoms of coccidioidomycosis?
fever; cough; headache; rash; muscle aches; joint pain

what may be complications for coccidioidomycosis?
chronic pneumonia;
meningitis;
bone or joint infections

*what classes of meds are used to tx coccidioidomycosis?*
*antifungals*

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