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Pathogenesis, Clinical Features and Diagnosis

References

Label Authors Title Source Year
1

References in context

  • Additional alterations in viral proteins may have contributed to the extremely high pathogenicity of the H1N1 Spanish flu pandemic virus of 1918 and that of the more recent avian H5N1 virus, which, in ongoing outbreaks thus far (March 1, 2006), has infected 179 people with a very high case fatality rate.1 A hallmark of virulence of highly pathogenic avian influenza viruses, such as the H5 subtype viruses, is the presence of the multibasic cleavage site in the HA molecule, as discussed in Chapter 2.
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Y Guan, LL Poon, CY Cheung, et al.. H5N1 influenza: a protean pandemic threat. Crossref. Proc Natl Acad Sci USA 101 (2004) (8156 - 8161) 2004
2

References in context

  • When a new influenza A subtype is introduced into the human population, the situation is different.
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  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

JK Taubenberger. The virulence of the 1918 pandemic influenza virus: unraveling the enigma. Crossref. Arch Virol Suppl 19 (2005) (101 - 115) 2005
3

References in context

  • When a new influenza A subtype is introduced into the human population, the situation is different.
    Go to context

  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

A Garcia-Sastre. Antiviral response in pandemic influenza viruses. Crossref. Emerg Infect Dis 12 (2006) (44 - 47) 2006
4

References in context

  • Influenza is a common illness during the winter months, but the overlap of symptoms with other respiratory illnesses and the practitioner's knowledge of whether influenza is circulating in the community is key to the diagnosis.
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  • With viral pneumonia, there is an interstitial pneumonitis with a predominantly mononuclear leucocyte infiltration. The alveolar walls become denuded of epithelium, hyaline membranes form, the intra-alveolar space becomes filled with exudate and haemorrhage from the surrounding capillaries, which significantly impairs the diffusion of gases.
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KG Nicholson, JM Wood, M Zambon. Influenza. Crossref. Lancet 362 (2003) (1733 - 1745) 2003
5

References in context

  • The effects of influenza on the naive immune system are evident in the high-risk population of children under the age of 2 years, with some protection mediated by maternal antibodies in infants less than 6 months old.5 Elderly people are particularly at risk for influenza illness, because of ageing effects on the immune system and the greater incidence of underlying medical conditions.
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WP Glezen, LH Taber, AL Frank, WC Gruber, PA Piedra. Influenza virus infections in infants. Crossref. Pediatr Infect Dis J 16 (1997) (1065 - 1068) 1997
6

References in context

  • Interestingly, the current cohort of older people appears to be less susceptible compared to young adults and children when H1N1 strains circulate in the community.6 This protection of older adults against H1N1-mediated illness has been attributed to priming with H1N1 strains that circulated during their childhood and may have generated protective immunological memory.
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AM McBean, PL Hebert. New estimates of influenza-related pneumonia and influenza hospitalizations among the elderly. Crossref. Int J Infect Dis 8 (2004) (227 - 235) 2004
7

References in context

  • The influenza virus causes a lytic infection of respiratory epithelial cells (see Chapter 2).
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M Loeb, A McGeer, M McArthur, RW Peeling, M Petric, AE Simor. Surveillance for outbreaks of respiratory tract infect-ions in nursing homes. Can Med Assoc J 162 (2000) (1133 - 1137) 2000
8

References in context

  • In particular, plasma IL-6 levels correspond to the severity of respiratory symptoms and fever in community-acquired influenza A illness, although serum levels of a number of other cytokines are elevated as well.8 Paradoxically, older people often do not mount a fever with influenza infection, even though IL-6 levels increase with age.
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L Kaiser, RS Fritz, SE Straus, L Gubareva, FG Hayden. Symptom pathogenesis during acute influenza: interleukin-6 and other cytokine responses. Crossref. J Med Virol 64 (2001) (262 - 268) 2001
9

References in context

  • The immune response to influenza has been presented in the previous chapter.
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S Vesa, M Kleemola, S Blomqvist, A Takala, T Kilpi, T Hovi. Epidemiology of documented viral respiratory infections and acute otitis media in a cohort of children followed from two to twenty-four months of age. Crossref. Pediatr Infect Dis J 20 (2001) (574 - 581) 2001
10

References in context

  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

AH Reid, JK Taubenberger. The 1918 flu and other influenza pandemics: “over there” and back again. Lab Invest 79 (1999) (95 - 101) 1999
11

References in context

  • Extensive sequence analyses of the 1918 virus genome, using RNA material rescued from bodies of victims of the pandemic, as well as reconstruction of viruses containing elements of the 1918 virus, have indicated that adaptation of the NS1 protein may have contributed to the extreme pathogenicity of the virus.
    Go to context

RG Webster. 1918 Spanish influenza: the secrets remain elusive. Crossref. Proc Natl Acad Sci USA 96 (1999) (1164 - 1166) 1999
12

References in context

  • The clinical presentation of influenza ranges from an asymptomatic infection or a self-limiting upper respiratory tract infection (URTI) to a severe illness, often with serious, potentially fatal, complications.12 The incubation period is 1–4 days, with an average of 2 days.
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  • In otherwise healthy individuals, influenza infection normally results in an uncomplicated URTI that resolves within 1–2 weeks.
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TR Cate. Clinical manifestations and consequences of influenza. Crossref. Am J Med 82 (1987) (15 - 19) 1987
13

References in context

  • In otherwise healthy individuals, influenza infection normally results in an uncomplicated URTI that resolves within 1–2 weeks.
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MG Ison, FG Hayden. Viral infections in immunocompromised patients: what's new with respiratory viruses?. Crossref. Curr Opin Infect Dis 15 (2002) (355 - 367) 2002
14

References in context

  • Myositis is reported more frequently in children with influenza B, but adults may also be affected and may develop rhabdomyolysis with acute renal failure.14 Cardiac complications, specifically myocarditis, have been described in patients with influenza A and B, but these complications are mostly asymptomatic.15 Pericarditis has been reported rarely.
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L Berry, S Braude. Influenza A infection with rhabdomyolysis and acute renal failure – a potentially fatal complication. Crossref. Postgrad Med J 67 (1991) (389 - 390) 1991
15

References in context

  • Myositis is reported more frequently in children with influenza B, but adults may also be affected and may develop rhabdomyolysis with acute renal failure.14 Cardiac complications, specifically myocarditis, have been described in patients with influenza A and B, but these complications are mostly asymptomatic.15 Pericarditis has been reported rarely.
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M Miura, Y Asaumi, Y Wada, et al.. A case of influenza subtype A virus-induced fulminant myocarditis: an experience of percutaneous cardio-pulmonary support (PCPS) treatment and immunohistochemical analysis. Crossref. Tohoku J Exp Med 195 (2001) (11 - 19) 2001
16

References in context

  • CNS complications are rare and range from irritability and confusion to psychosis and severe encephalopathy due to a variety of inflammatory processes, including Reye's syndrome.16 Recovery is usually complete.
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S Kimura, N Ohtuki, A Nezu, M Tanaka, S Takeshita. Clinical and radiological variability of influenza-related encephalopathy or encephalitis. Crossref. Acta Paediatr Jpn 40 (1998) (264 - 270) 1998
17

References in context

  • A small increase in the incidence of Guillain–Barré syndrome (GBS) (1–2 excess cases per million against a background of 10–20 cases per million) has been reported after influenza vaccination.17 However, it is unclear whether this marginal increase is truly associated with influenza vaccination, while, even if it is, the risk is considerably smaller than the risk of death from influenza or its complications, particularly in high-risk groups (see below).
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T Lasky, GJ Terracciano, L Magder, et al.. The Guillain–Barré syndrome and the 1992–1993 and 1993–1994 influenza vaccines. Crossref. New Engl J Med 339 (1998) (1797 - 1802) 1998
18

References in context

  • Myositis is reported more frequently in children with influenza B, but adults may also be affected and may develop rhabdomyolysis with acute renal failure.14 Cardiac complications, specifically myocarditis, have been described in patients with influenza A and B, but these complications are mostly asymptomatic.15 Pericarditis has been reported rarely.
    Go to context

U Heininger. An update on the prevention of influenza in children and adolescents. Crossref. Eur J Pediatr 162 (2003) (828 - 836) 2003
19

References in context

  • Infants and children under the age of 2 years will generally have a naive immune system and potentially compromised ability to mount an effective immune response to influenza.
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TM Uyeki. Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J 22 (2003) (164 - 177) 2003
20

References in context

  • It is therefore not surprising that influenza and pneumonia represent one of the six leading causes of catastrophic disability in the population of 65 years and above.20 Gastrointestinal symptoms also tend to be more common, especially with influenza B.
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L Ferrucci, JM Guralnik, M Pahor, MC Corti, RJ Havlik. Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled [see comments]. J Am Med Assoc 277 (1997) (728 - 734) 1997
21

References in context

  • Recent studies have linked annual outbreaks of influenza to excess mortality during the winter months due to heart attacks, strokes, and exacerbations of diabetes and congestive heart failure during the winter months in the population of 70 years and older.21,22 These observations point to a potentially enhanced inflammatory basis of influenza illness and related complications in older people.
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TA Reichert, L Simonsen, A Sharma, et al.. Influenza and the winter increase in mortality in the United States, 1959–1999. Crossref. Am J Epidemiol 160 (2004) (492 - 502) 2004
22

References in context

  • Recent studies have linked annual outbreaks of influenza to excess mortality during the winter months due to heart attacks, strokes, and exacerbations of diabetes and congestive heart failure during the winter months in the population of 70 years and older.21,22 These observations point to a potentially enhanced inflammatory basis of influenza illness and related complications in older people.
    Go to context

DM Fleming, KW Cross, RS Pannell. Influenza and its relationship to circulatory disorders. Crossref. Epidemiol Infect 133 (2005) (255 - 262) 2005
23
M Loeb. Pneumonia in the elderly. Crossref. Curr Opin Infect Dis 17 (2004) (127 - 130) 2004
24

References in context

  • Cough is the most common presenting symptom of influenza in this population and presents a diagnostic challenge to the physician.24 More than 90% of influenza-associated excess deaths occur in the elderly of 65 years and older, and thus prevention, diagnosis and appropriate management of illness have a significant impact on health outcomes in this population.25 People aged 50–65 years are also at greater risk due to the increased rate of chronic medical conditions, such as diabetes and cardiac, pulmonary or renal diseases, and immunocompromising conditions or medications.
    Go to context

J Widdicombe, S Kamath. Acute cough in the elderly: aetiology, diagnosis and therapy. Crossref. Drugs Aging 21 (2004) (243 - 258) 2004
25

References in context

  • Cough is the most common presenting symptom of influenza in this population and presents a diagnostic challenge to the physician.24 More than 90% of influenza-associated excess deaths occur in the elderly of 65 years and older, and thus prevention, diagnosis and appropriate management of illness have a significant impact on health outcomes in this population.25 People aged 50–65 years are also at greater risk due to the increased rate of chronic medical conditions, such as diabetes and cardiac, pulmonary or renal diseases, and immunocompromising conditions or medications.
    Go to context

JP Janssens, KH Krause. Pneumonia in the very old. Crossref. Lancet Infect Dis 4 (2004) (112 - 124) 2004
26

References in context

  • Influenza is more common in immunocompromised individuals (32%) than community controls (14%) and can cause severe disease.26 Pneumonia (usually viral) is more common and mortality is higher.
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RA Vilchez, J Fung, S Kusne. The pathogenesis and management of influenza virus infection in organ transplant recipients. Crossref. Transpl Infect Dis 4 (2002) (177 - 182) 2002
27

References in context

  • Prolonged shedding of influenza virus (up to 5 months) and rapid emergence of resistance to amantadine and rimantadine (see Chapter 7) have been observed in immunocompromised individuals.27 HIV infection is not generally associated with more severe influenza illness.
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JA Englund, RE Champlin, PR Wyde, et al.. Common emergence of amantadine- and rimantadine-resistant influenza A viruses in symptomatic immunocompromised adults. Clin Infect Dis 26 (1998) (1418 - 1424) 1998
28

References in context

  • Women in the second or third trimester of pregnancy have an increased risk of hospitalization due to cardiorespiratory complications.28 The risk is greatest in pregnant women with mitral valve disease, who have a 45% mortality rate associated with influenza infection (higher if labour occurs during influenza infection).
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WS Lim, JT Macfarlane, CL Colthorpe. Treatment of community-acquired lower respiratory tract infections during pregnancy. Crossref. Am J Respir Med 2 (2003) (221 - 233) 2003
29

References in context

  • Additional criteria are used in epidemiological studies to estimate attack rates and vaccine effectiveness, and to define clinical case definitions during the peak influenza period.29 The most specific clinical case definition of influenza is “febrile upper respiratory illness” (URI), defined as 2 days of URI symptoms (runny nose, sore throat, cough) with two or more symptoms on at least 1 day and fever on at least 1 day.
    Go to context

KL Nichol, P Mendelman. Influence of clinical case definitions with differing levels of sensitivity and specificity on estimates of the relative and absolute health benefits of influenza vaccination among healthy working adults and implications for economic analyses. Crossref. Virus Res 103 (2004) (3 - 8) 2004
30

References in context

  • However, the sensitivity and specificity vary widely, and the positive and negative predictive value of these tests is highly dependent on whether or not influenza is circulating in the local community – the contribution of these tests to clinical diagnosis thus needs to be carefully considered.30 Rapid influenza tests have been developed but have some limitations (see below under “Antigen detection”).
    Go to context

TM File. Community-acquired pneumonia. Crossref. Lancet 362 (2003) (1991 - 2001) 2003
31

References in context

  • Although labour-intensive and usually slower than other tests, RT–PCR is used to type and subtype influenza infections.31 Either clinical or cell culture specimens can be used.
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KE Templeton, SA Scheltinga, MF Beersma, AC Kroes, EC Claas. Rapid and sensitive method using multiplex real-time PCR for diagnosis of infections by influenza A and influenza B viruses, respiratory syncytial virus, and parainfluenza viruses 1, 2, 3, and 4. Crossref. J Clin Microbiol 42 (2004) (1564 - 1569) 2004
32

References in context

  • In addition, the collection of patient samples for virus culture and identification is critical to maintaining the network for influenza surveillance that determines the onset, peak and resolution of an influenza activity in the community.32 The primary mode of influenza prevention is vaccination (see Chapter 8).
    Go to context

TJ Meerhoff, A Meijer, WJ Paget. Methods for sentinel virological surveillance of influenza in Europe – an 18-country survey. Eur Surveill 9 (2004) (1 - 4) 2004
33

References in context

CW Potter. Chronicle of influenza pandemics. KG Nicholson, RG Webster, AJ Hay (Eds.) Textbook of Influenza (Blackwell Science, Oxford, 1998) (3 - 18) 1998

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