The Flu … and TB

Mary J. Aigner RN,

MSN, FNPC
 The flu … why care?
✏ Highly contagious
✏ May be infectious and able to spread
✏ Before symptoms start (Adults 1 day, Kids 5d)
✏ Up to 5(A)/10(K) days after symptoms appear
✏ Severely immunocompromised can shed virus for weeks or
months

✏ Primarily
person-to-person via large droplets (> 5ųm
diameter)
✏ From cough, sneeze
 How many affected?
✏ 1979-80 through 2000-01
✏ # flu related hospitalizations
✏ Range:54,000 to 430,000
✏ Average: 226,000 per year
✏ 63% hospitalized > or = 65 years

✏ Deaths
✏ 36K deaths/year average (1990-1999)
✏ Usufrom pneumonia or cardiac exascerbations or
chronic diseases
✏ Most > or = 65 years (90% of deaths from px or flu)
 More data (from CDC)
✏ InU.S. - # deaths related to flu has
increased
✏ WHY?
✏ Deaths uncommon in children
✏ With or without high-risk conditions
✏ During1990’s: average 0.4/100,000 (< 5yrs)
✏ Same time, adults averaged 98.3/100K (>=65)
Initial Symptoms (p 633)
✏ Severe HA
✏ Muscle aches
✏ Fever
✏ Chills
✏ Fatigue
✏ Weakness
✏ anorexia
 More manifestations
✏ Sore throat
✏ Cough
✏ Rhinorrhea
✏ (watery discharge)

✏ Fatigue x 1-2 weeks

after acute episode
resolved
Treatment ✏ Antiviral meds (633)
✏ Need script
✏ Symptomatic ✏ Older drugs
✏ Amantadine
✏ Fever - Tylenol
✏ Pain - Tylenol
(Symmetrel)
✏ Rimantadine (Flumadine)
✏ Lots of fluids
✏ Rest and More rest ✏ Newer drugs
✏ Zanamivir (Relenza)
✏ Cough syrup
✏ Oral inhalant
✏ Saline gargles ✏ Oseltamivir (Tamiflu)
✏ Or throat spray ✏ Both can be used as
✏ Antihistamines prevention or treatment
✏ For rhinorrhea (within 24-48 hours)
 Prevention of Flu
✏ Flu vaccine
✏ Changed yearly based on most likely viral
strains to appear during season
✏ When is the typical flu season?
✏ Given IM, 0.5 ml. - usu in arm
✏ Or nasal spray
✏ (jury still out on effectiveness w/adults)
✏ Recommended for > 50 yrs, chronic illness,
immunocompromised, live in institutions, health
care workers
 *variant of
A/New
Caledonia
Used 2006-7
2007-08 Flu Vaccine
Per recommendations of WHO
For Northern Hemisphere,
contains:
✏ A/Solomon Islands*
✏ 3/2006-like
✏ H1N1
✏ A/Wisconsin
✏ 67/2005-like
✏ H3N2
✏ B/Malaysia
✏ 2506/2004-like
✏
What do the letters & numbers
mean?
✏ The “H” stands for hemagglutinin
✏ 500 molecules of h. make one virion
✏ It determines extent of infection in host
✏ There are 16 subtypes labeled with “H”
✏ The “N” stands for neuraminidase
✏ Nine different “N” subtypes
✏ So… the number stands for the
specific subtype
 Like it or not…here’s more
✏ Most known strains are now extinct
✏ Sometimes, variants are named for
species virus adapted to, or endemic in
✏ Bird flu (or Avian flu)
✏ Human flu
✏ Swine flu
✏ Horse flu (Tell about
✏ Dog flu ravens)
 Still More
✏ Influenza A virus ✏ Influenza B virus
✏ Family called ✏ No sub-categories
Orthomyxoviridae ✏ Slower antigenic
✏ RNA virus drift than A virus
✏H and N are 2 of 11 ✏ (mutates slower)
proteins in virus
✏ All A subtypes ✏ So what might this
affect birds (hosted mean for humans?
by birds)
✏ Some in mammals
 CDC: Guidelines for Prevention &
Control of Flu in Acute-Care Facilities
✏ Vaccination
✏ All health-care personnel & high-risk
✏ Infection Control measures
✏ Surveillance
✏ Education
✏ Flu testing
✏ Respiratory hygiene/cough etiquette
✏ Standard precautions
✏ Droplet precautions
✏ Antiviral prophylaxis
✏ Restrictions for Ill visitors or personnel
Let’s check out the
Let’s take a
break!
 TB pathophys
✏ Caused by Mycobacterium tuberculosis
✏ Most common infection worldwide
✏ Transmitted via aerosolization
✏ Cough, laugh, sneez, whistle, sing
✏ More infected with bacillus but don’t
develop active TB
 So what happens?
✏ Bacillus multiples in bronchi/alveoli
✏ Exudative response occurs
✏ Causes pneumonitis
✏ Body develops immunity
✏ Further growth usually controlled
✏ Lesions resolve - little or no bacillus left
✏ BUT - small % develop active TB
✏ 5-15%
Active TB - pg 640
✏ Greatest risk:
✏ People who are HIV (-) 2
yrs after infection

✏ OK class - does that

make sense to anyone?
 Immunity & Infection
✏ Cell mediated immunity develops
✏ 2-10 weeks after infection
✏ + PPD test (conversion)
✏ Primary infection small
✏ Will not show on CXR
✏ 1) granulomatous inflammation (p 640),
2) caseation necrosis (if shows on CXR,
called a Ghon tubercle or primary lesion)
 And then …
✏ Areas of caseation undergo
✏ Resorption,
✏ Degeneration
✏ Fibrosis
✏ Necrotic areas may calcify or liquefy
✏ If liquid – material empties into bronchus –
causes cavity (cavitation)
✏ During all of this, bacilli are growing and
spreading through lymph into more of lungs
 It can also …
✏ Lesions may progess during inflammation
stage
✏ Bacilli multiply rapidly
✏ Extends through the pleura
✏ Causes pleural or pericardial effusion
✏ Miliary or hematogenous TB
✏ Spreads throughout body as organisms enter
bloodstream
✏ Brain, mininges, liver, kidney, bone marrow
 Initially
✏ Infection most often in
✏ Middle or lower lobes
✏ Local lymph nodes infected, enlarged

✏ Then – period of asymptoms

✏ Years or decades before symptoms again
✏ Person is NOT infectious (although infected)
until symptoms reoccur
 Secondary TB
✏ Reactivation of disease
✏ In previously infected person
✏ More likely when host defenses lowered
✏ Eg. older, HIV
✏ Usu in upper lobes
✏ Called Simon’s foci

✏ See page 631, T34-8 for classifications

Risk of Transmission
✏ Reduced after
infected person
✏ has been on meds
for 2-3 weeks
✏ Clinically better
✏ Bacilli in sputum
reduced
FEARLESS