This is just a worksheet to share ideas about how to treat H5N1 influenza based on published symptoms.
The symptoms listed were found in NEJM Sept 2005, Influenza Report, and an article in Chest. See H5N1 page here. The level of medical terms is difficult. For a treatment guide for the average person see the FluWiki index or buy Dr Grattan Woodson’s Bird Flu Manual.
Official guidance for treating human infections if H5N1 influenza is not detailed.
Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic British expert group guidelines published in Jan 2007 journal, “Thorax.”
WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus
HHS Pandemic Influenza Plan Clinical Guidelines
Treatment and Prophylaxis of Influenza on Influenza Report
In the process of developing this page these sites may be useful Merck Manual and Medline Plus to complete the information below. The Stedman Medical Dictionary is available on eMedicine.com.
Clinical Presentation Acute Respiratory Distress Syndrome (ARDS)
Description ARDS is respiratory failure caused by acute lung injury from viral pneumonia or pulmonary edema. Also described as diffuse alveolar damage (DAD). Mortality rate averages 60%. Cause of death often multiple organ dysfunction syndrome (MODS) or systemic inflammatory response syndrome (SIRS also known as sepsis).
How To Measure Decreased arterial oxygen (hypoxemia) and carbon dioxide (hypocapna) levels. Rapid breathing (tachypnea). Crackles heard in lungs. Dark blue/purple discoloration of skin, nails, lips, or mucous membranes due to low oxygen levels (cyanosis).
How To Treat Nearly all ALI/ARDS patients require endotracheal intubation and mechanical ventilation during the acute phase of their illness. A few patients with ALI can be managed with high fractional inspired O2 (Fio2) delivered by face mask alone, or with noninvasive positive pressure ventilation (NIPPV) delivered by face mask, which effectively delivers positive end-expiratory pressure (PEEP).
It is also important to recognize and treat pneumonia quickly, manage multiple organ failure, and maintain nutritional support. Essential nutrients and fatty acids EPA and GLA which are found in borage oil and fish oil. A product used for patients is OXEPA. It has been shown to reduce inflammation, improve oxygenation, reduce need for mechanical ventilation. Some treatments that have shown successful treatment have not consistently proven to decrease mortality. These include prone posistioning, fluid management, supplemental nitric oxide, surfactant replacement therapy, anti-inflammatories and corticosteroids. Drotrecogin alfa (Xigris) may help patients with severe sepsis induced ARDS. (according to Mayo Clinic)
Acute Respiratory Distress Syndrome
ARDS on Merck Manual
Clinical Presentation Aminotransferase levels increased
Description Aminotransferase is an enzyme that catalyzes the transfer of an amino group from a donor molecule to a recipient molecule. There is alanine aminotransferase and aspartate aminotransferase.
How To Measure Liver panel lab testing describred by American Association for Clinical Chemistry
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Clinical Presentation Cough
Description A cough occurs when the lungs suddenly push out air. Coughing is a reflex. It happens to the body automatically. The force of a cough can clear an airway that is blocked. It clears mucus and pus from the airways. Irritation in the throat can cause a cough. Virtual Pediatric Hospital
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How To Treat Cough lozenges or hard candy can help dry, tickling coughs. These should never be given to a child under 3 years old because they may cause choking. A vaporizer or steamy shower may help a dry cough by increasing the humidity in the air. Drink extra fluids to help thin the secretions in your throat and make them easier to cough up. Medline Plus Expectorants and Mucolytics are sometimes given to move phlegm (need citations). Codeine is used, usually in combination with other medications, to reduce coughing. It also is used to relieve mild to moderate pain. MedlinePlus
Clinical Presentation Diarrhea (watery) without blood or inflammatory changes.
Description An abnormally frequent discharge of semisolid or fluid fecal matter from the bowel. This condition can occur as a symptom of infection, allergy, food intolerance, and foodborne illness.
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How To Treat Give Oral Rehydration Solution to prevent dehydration . Treatment of Diarrhoea A Manual for Physician’s and other senior healthcare workers. WHO. Antimotility drugs like Loperamide, also known as Imodium, are not recommended for infants or people with fever because they can delay clearance of infectious organisms.
Clinical Presentation Disseminated intravascular coagulation (DIC)
Description increased propensity for clot formation triggered by a variety of stimuli related to such diverse disorders as sepsis, etc. DIC is a disorder of the “clotting cascade.” It results in depletion of clotting factors in the blood. Alveola are the air cells of the lungs that allow oxygen to pass into the blood stream (gas exchange). DAD evolves through successive stages. Initially there is protein rich edema, followed by the typical exudative phase with hyaline membranes (like scabs along alveolar ducts) and inflammation. If the process does not resolve within the first week it can organize, resulting in fibrosis. Adult respiratory distress syndrome is characterised by fulminant interstitial and alveolar oedema which usually develops 12 to 48 hours after an initial trauma. It results from increased alveolar capillary permeability and is not cardiogenic in origin. Endothelial cell damage (direct, secondary to inflammatory cells and mediators esp neutrophils, due to endotoxin) • Capillary leak into the alveolae with accumulation of edema and proteinaceous, necrotic material that forms hyaline membranes • Edema interferes with gas exchange,
How To Measure Fibrinogen or fibrin - high degradation products, Serum fibrinogen - low, Prothrombin time (PT) - high, Partial throboplastin time (PTT) - high, Platelet count, Thrombin time test. Severe abnormalities in pulmonary gas exchange - defined by a PaO2:FiO2 ratio < 20 KPa?
How To Treat “Sustained infusion of intravenous salbutamol (albuterol) shows encouraging results in a trial in patients with alveolar edema, British researchers report in the February issue of the American Journal of Respiratory and Critical Care Medicine. Am J Respir Crit Care Med 2006:173:281–287, 254–255.”
Disseminated intravascular coagulation on eMEdicine from WebMD
Clinical Presentation Dyspnea
Description shortness of breath, difficult or labored respiration, Dyspnea from Merck Manual Chpt 63
How To Measure Pulmonary Function Testing from Merck Manual
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Dyspnea Symptom Management from Lung Cancer Alliance
Respiratory Failure on eMedicine by WebMD
Clinical Presentation Encephalitis
Description “Encephalitis” means “inflammation of the brain,” but it usually refers to brain inflammation caused by a virus. Symptoms may include fever, severe headache, nausea and vomiting, stiff neck, confusion, disorientation, personality changes, convulsions (seizures), problems with speech or hearing, hallucinations, memory loss, drowsiness, coma.
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Encephalitis on Mayo Clinic Encephalitis on eMedicine from WebMD
Clinical Presentation Encephalopathy
Description Encehalopathy is a term for any diffuse disease of the brain that alters brain function or structure. Common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness. However, the encephalopathy may cause permanent structural changes and irreversible damage to the brain. Some encephalopathies can be fatal.
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How To Treat Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed.
adapted from National Institute for Neurological Disorders
Clinical Presentation Fever
Description The average normal body temperature is 98.6°F (37°C). A “significant” fever is usually defined as an oral or ear temperature of 102 F or a rectal temperature of 103 F. A rectal temperature reading is generally 1 degree Fahrenheit higher than an oral reading.
How To Measure Thermometer, oral, rectal, ear, or forehead.
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Fever describe on Mayo Clinic Fever in MedLine Encyclopedia Fever on Wikipedia
Clinical Presentation Gastroenteritis
Description Gastroenteritis is a nonspecific term for various pathologic states of the gastrointestinal tract. The primary manifestation is diarrhea, but it may be accompanied by nausea, vomiting, and abdominal pain.
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Gastroenteritis on eMedicine by WebMD Gastroenteritis on Mayo Clinic Gastroenteritis on WIkipedia
Clinical Presentation Hemophagocytic syndrome
Description Hemophagocytic syndrome (HPS) is a nonmalignant syndrome characterized by an expansion of the monocyte-macrophage population and intense hemophagocytosis. It is characterized by a proliferation of histiocytes with phagocytosis of formed elements of blood. Clinical manifestations include signs and symptoms of immune activation and decreased peripheral blood cell counts.
How To Measure Diagnostic criteria include idiopathic fever, splenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogenemia, and the presence of hemophagocytosis.
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Clinical Presentation Hyperglycemia complications from corticosteroid treatment
Description Hyperglycemia is an abnormally high concentration of glucose in the blood, a feature of diabetes mellitus.
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Clinical Presentation Infiltrates, interstitial
Description Appearance of an ill-defined opacity on the chest radiograph (x-ray) caused by cells or fluid in the spaces of the lung. Lung damage is generally irreversable.
How To Measure High-resolution computerized tomography (HRCT) scan uses an X-ray-sensing unit and a large computer to create cross-sectional images that are far more detailed than a traditional x-ray.
How To Treat Corticosteroid drugs, the most common treatment, occasionally can slow the damage of interstitial lung disease, but many people never regain full use of their lungs. Cytotoxic drugs like Azathioprine may also be prescribed when corticosteriods alone fail to work. The efficacy of this is unknown. Antifibrotics drugs are used to help reduce the development of scar tissue but are not always sucessful. Oxygen therapy can make breathing easier. Pulmonary rehabilitation involves breathing exercises.
Lymphoid Interstitial Pneumonia on Merck Interstitial Lung Disease on Mayo Clinic
Clinical Presentation Leukocyte count decreased
Description A Leukocyte is also known as a white blood cell. Stedman definition
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Clinical Presentation Lymphoid tissue necrosis and atrophy
Description The lymphatic system acts as a secondary circulatory system, except that it collaborates with white blood cells in lymph nodes to protect the body from being infected by cancer cells, fungi, viruses or bacteria. Lymph consists of a clear liquid portion, varying numbers of white blood cells (chiefly lymphocytes), and a few red blood cells. Necrosis is the death of cells, tissue or an organ. Atrophy is a wasting of tissues.
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Lymphatic system on Wikipedia
Clinical Presentation Lymphopenia
Description “Low total peripheral white blood cell count. A white blood cell formed in lymphatic tissue throughout the body (Example: lymph nodes, spleen, thymus, tonsils, Peyer patches, and sometimes in bone marrow) and in normal adults making up approximately 22–28% of the total number of leukocytes in the circulating blood. Lymphocytes are generally small (7–8 µm), but larger forms are frequent (10–20 µm); with Wright (or a similar) stain, the nucleus is deeply colored (purple-blue), and is composed of dense aggregates of chromatin within a sharply defined nuclear membrane; the nucleus is usually round, but may be slightly indented, and is eccentrically situated within a relatively small amount of light blue cytoplasm that ordinarily contains no granules; especially in larger forms, the cytoplasm may be fairly abundant and include several bright red-violet fine granules; in contrast to granules of the myeloid series of cells, those in lymphocytes do not yield a positive oxidase or peroxidase reaction. Lymphocytes are divided into 2 principal groups, termed T and B cells, based on their surface molecules as well as function. Natural killer cells, which are large granular lymphocytes, represent a small percentage of the lymphocyte population. syn: lymph cell”
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Lymphopenia on Wikipedia
Clinical Presentation Malaise
Description A general feeling of discomfort. Often the first indication of disease.
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Clinical Presentation Multiple Organ Dysfunction Syndrome (MODS)
Description The presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention.
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Multiple Organ Dysfunction Syndrome on Wikipedia
Clinical Presentation Myalgia
Description muscle aches and pain
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How To Treat acetaminophen or ibuprofen, rest, warmth
Myalgia on Wikipedia
Clinical Presentation Platelet count decreased
Description An irregularly shaped disklike cytoplasmic fragment of a megakaryocyte that is shed in the marrow sinus and subsequently found in the peripheral blood, where it functions in clotting. A platelet contains granules in the central part (granulomere) and, peripherally, clear protoplasm (hyalomere), but no definite nucleus; is about one-third to one-half the size of an erythrocyte; and contains no hemoglobin.
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Clinical Presentation Pleuritic pain
Description
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Clinical Presentation Pneumonia
Description Inflammation of the lung parenchyma characterized by consolidation of the affected part, the alveolar air spaces being filled with exudate, inflammatory cells, and fibrin. Most cases are due to infection by bacteria or viruses, a few to inhalation of chemicals or trauma to the chest wall, and a small minority to rickettsiae, fungi, and yeasts. Distribution may be lobar, segmental, or lobular; when lobular and in associated with bronchitis, it is termed bronchopneumonia.
How To Measure Pneumonia Severity Index Calculator
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Clinical Presentation Proinflammatory cytokine cascade
Description
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Clinical Presentation Pulmonary infiltrates
Description
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Clinical Presentation Rhinitis (although upper respiratory symptoms may be absent)
Description Rhinistis is defined as Runny nose, Sneezing, Watery nasal drainage (rhinorrhea), Blood vessel congestion of the mucous membranes in the nose. (I don’t know how you can have this while UR symptoms may be absent.)
How To Measure Blood tests to determine total serum IgE and total circulating eosinophil count may be ordered.
How To Treat antihistamines, decongestants,
Clinical Presentation Segmental or lobular consolidation with air bronchograms.
Description A reduction, relative or absolute, in the number of lymphocytes in the circulating blood.
How To Measure Solidification into a firm dense mass; applied especially to inflammatory induration of a normally aerated lung due to the presence of cellular exudate in the pulmonary alveoli as commonly seen in pneumonia. Etymology: L. [consolido,] to make thick, condense, fr. [solidus,] solid
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Clinical Presentation Sputum production is variable and sometimes bloody.
Description
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Clinical Presentation Systemic inflammatory response syndrome
Description
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Clinical Presentation Tachypnea
Description tachypnea (or “tachypnoea”) (Greek: “rapid breathing”) is characterized by rapid breathing and is not identical with hyperventilation - tachypnea may be necessary for a sufficient gas-exchange of the body, for example after exercise.
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Aspiration from Pneumonia on eMedicine by WebMD
Clinical Presentation Thrombocytopenia
Description Thrombocytopenia is the medical term for a low blood platelet count. Platelets (thrombocytes) are colorless blood cells that play an important role in blood clotting. They stop blood loss by clumping together at the site of a blood vessel injury and forming plugs in vessel holes. Reduced white blood cells (lymphocytes) in the blood.
How To Measure Laboratory tests might include: full blood count, liver enzymes, renal function, vitamin B12 levels, folic acid levels, erythrocyte sedimentation rate.
Signs and symptoms of a low blood platelet count may include:
- Easy or excessive bruising
- Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
- Prolonged bleeding from cuts
- Spontaneous bleeding from your gums or nose
- Blood in urine or stools
- Unusually heavy menstrual flows
- Profuse bleeding during surgery
Serious or widespread bleeding indicates an emergency and requires immediate care.
How To Treat Treating thrombocytopenia may involve several options: Medications For idiopathic thrombocytopenic purpura, treatment may include medications that block the antibodies that attack platelets, such as corticosteroids, or medications that suppress the immune system to reduce antibody formation, such as cyclophosphamide (Cytoxan) or azathioprine (Imuran). Surgery Sometimes, removing the spleen (splenectomy) relieves signs and symptoms or helps improve chronic idiopathic thrombocytopenic purpura that doesn’t respond to corticosteroids. Blood transfusions and plasma exchange For severe bleeding, your doctor can replace lost blood with transfusions of packed red blood cells. Platelet concentrates are given to treat severe thrombocytopenia, particularly those related to cancer or chemotherapy. Thrombotic thrombocytopenic purpura requires emergency treatment with plasma exchange therapy or therapeutic plasmapheresis. If you have hemolytic uremic syndrome, you may need kidney dialysis in addition to red blood cell and platelet transfusions.
Thrombocytopenia on Mayo Clinic http://www.emedicine.com/med/topic1151.htm | Immune Thrombocytopenic Purpurea on eMedicine by WebMD ]] Thrombocytopenia on Wikipedia
Clinical Presentation Viremia
Description Viral infection in the blood (also known as sepsis).
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Clinical Presentation Vomiting
Description Vomiting is forcing the contents of the stomach up through the esophagus and out of the mouth.
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Clinical Presentation Viral pneumonia
Description Viral pneumonia occurs due to aggression of the viral pathogens on the lung structures.
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Viral Pneumonia entry on eMedicine by WebMD
another Viral Pneumonia entry on eMedicine by WebMD
Temporarily posted a Flu Treatment Database 1mb MS Access database.
The database should eventually be revised based on the completed information on this page. For now it is based on possible treatments for influenza, pneumonia, and acute respiratory distress syndrome (ARDS). The list may be printed for reference when a good report format is completed. For determining a specific treatment plan the complete information (monograph) for a drug or supplement should be printed. This should be reviewed by a doctor or pharmacist to confirm there is no problem with preexisting conditions or other medications you are taking. Not all the items listed are appropriate but are included for completeness (it is important to know what have been considered but does not work). I do not recommend that anyone self medicate. This may simplify work for doctors by providing a concise list of possible pandemic treatments. This worksheet is only a place where I am trying to find links to authoritative information. The inclusion of any drug or supplement listed is not an endorsement.