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);
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?

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

what is the most common complication for influenza?

*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?*
*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*;

*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*;

*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)*;
*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;

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

what are symptoms of RSV pneumonia?
nonproductive cough;

what are common PE findings for RSV pneumonia?

what are signs and symptoms of parainfluenza pneumonia?
dyspnea with rales and wheezing

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

*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;
bone or joint infections

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

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