Influenza - home health advice

Overview
Definition

Influenza is a viral infection of the respiratory tract. Symptoms are usually systemic, though, involving other organ systems, and more severe than those of other viral respiratory infections. Regional and local influenza epidemics lasting three to six weeks occur almost every winter. While most cases run their course in one to two weeks, life-threatening complications such as pneumonia are possible, especially in the elderly and in patients with chronic illnesses. Between 20,000 and 40,000 people die of influenza in the United States annually, and pandemics occurring a few times a century may kill many more.
Etiology

There are three main types of orthomyxoviruses that cause influenza.

* Influenza A: Responsible for near-annual epidemics of disease with relatively severe symptoms. Mutates by gradual antigenic drift and also by occasional abrupt protein changes (antigenic shift) which can cause pandemics, as occurred most recently in 1918 ("Spanish flu"), 1957 ("Asian flu"), and 1968 ("Hong Kong flu").
* Influenza B: Near-annual outbreaks, but usually less serious than type A influenza. Mutates by antigenic drift only.
* Influenza C: Causes mild illness, or is asymptomatic. Not responsible for epidemics. Antigenically stable.

The viruses are mainly spread via aerosols of respiratory secretions released through sneezing and coughing.
Risk Factors

* Age (highest risk in school-age children and the elderly)
* Healthcare provider
* Residence in a nursing home or other chronic care facility
* Chronic cardiovascular or pulmonary disorders (including asthma)
* Compromised immune system

Signs and Symptoms

* Sudden onset of fever (101 to 104?F)
* Chills
* Headache
* Muscle aches
* Fatigue
* Nonproductive cough
* Sore throat
* Sneezing, rhinorrhea, and/or nasal obstruction
* Loss of appetite
* Nausea, vomiting, or diarrhea, especially in children

Differential Diagnosis

* Common cold
* Pharyngitis
* Laryngitis
* Herpes esophagitis
* Bronchitis
* Pneumonia

Diagnosis
Physical Examination

Patients appear ill, febrile, and coughing. They may not exhibit all the classical symptoms, but evidence of upper respiratory infection is generally apparent. Lungs are usually clear.
Imaging

Chest X rays should be taken if complicating pneumonia is suspected.
Other Diagnostic Procedures

Diagnosis may often be made by symptoms alone, particularly when an epidemic is underway.
Treatment Options
Treatment Strategy

Specific antiviral therapies are available for influenza. Medications are given to relieve symptoms until the antivirals take effect. Relieve symptoms of influenza with OTC acetaminophen, ibuprofen, cough suppressant, and decongestant. Aspirin should not be given to children or teenagers with a viral illness because of the risk of Reye's syndrome. Complementary therapies can be part of this process. Antibiotics are not effective against the viruses that cause influenza; however, some healthcare providers choose to administer them to patients particularly vulnerable to complicating bacterial pneumonia. Rest and fluids are recommended.
Drug Therapies

Antiviral drugs amantadine (100 mg bid for 10 days) or rimantadine (100 mg bid for 5 to 7 days in those age 10 and older) should be taken prior to or soon after exposure, and are effective against influenza A only. When administered within 48 hours of illness onset, neuraminidase inhibitors oseltamivir (75 mg po bid for 5 days in those age 18 or older) and zanamivir (10 mg inhaled bid for 5 days in those age 7 and older) can reduce the severity and duration of signs and symptoms of influenza A, and can reduce the duration of influenza A and B viruses by approximately 1 day; neither is approved for prevention.
Complementary and Alternative Therapies

A combination of herbs and nutrition may be quite effective at relieving symptoms and speeding healing. The backbone of treatment, as stated earlier, is rest and fluids. The correct homeopathic treatment can be helpful in relieving symptoms.
Nutrition

* Vitamin C (1000 mg tid to qid), vitamin A (25,000 IU/day) or beta-carotene (200,000 IU/day), and zinc (25 to 90 mg/day) are nutrients that optimize immune system functioning. High doses of vitamin A are contraindicated in women who are or may become pregnant in the next three months. High doses of vitamin A and zinc should not be used for longer than two to six weeks. Some practitioners recommend 300,000 IU of vitamin A for three days, then 150,000 IU for three days.
* Sugar may diminish lymphocyte and neutrophil activity, so decreased consumption seems warranted.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

* Coneflower (Echinacea angustifolia) immune modulating
* Goldenseal (Hydrastis canadensis) immune modulating, antimicrobial, bitter, astringent
* Licorice (Glycyrrhiza glabra) antiviral, anticolic, soothing to mucous membranes; should not be used in the case of hypertension
* Yarrow (Achillea millefolium) antibacterial, astringent, antispasmodic, especially with fever
* Elder (Sambucus nigra) diaphoretic, anticatarrhal, especially for lungs
* St. John's wort (Hypericum perforatum) antiviral, pain relief
* Mix a combination of coneflower and goldenseal with two to four of the other herbs listed. Drink 3 to 6 cups tea/day, or take 30 to 60 drops tincture three to six times/day.
* Garlic/ginger tea (2 to 3 cloves of garlic and 2 to 3 slices of fresh ginger) drunk as a tea keeps the lungs clear and acts as an antimicrobial. May be used in addition to above herbs.

Homeopathy

An experienced homeopath would assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

* Nisylen? (combination remedy of Aconite, Gelsemium, Eucalyptus, Ipecacuanha, Phosphorus, Bryonia, and Eupatorium perfoliatum)?
* Oscillococcinum (active ingredients Anas barbarice hepatis et cordis extractum HPUS 200CK) can be very effective
* Gelsemium for influenza in the patient with symptoms of weakness, forgetfulness, and diarrhea
* Eupatorium perfoliatum for influenza with deep achiness, as well as sneezing and coughing
* Nux vomica for influenza with violent vomiting and irritability

Acupuncture

May be helpful at alleviating symptoms and speeding healing. Usually very helpful in decreasing length and severity of symptoms.
Patient Monitoring

Elderly patients, or those who have underlying renal insufficiency, seizure disorders, or psychosis, should be carefully monitored while on antiviral drugs, as there have been occasional cases of seizures, hallucinations, and delirium, particularly with high doses.
Other Considerations
Prevention

Each year a killed-virus vaccine is prepared based on expectations (based on antigenic and gene sequence changes) of the virus types that will be circulating that winter. The vaccines are 70 to 90% effective if administered before the flu season. Side effects have generally been minor, with the exception of an increased rate of Guillain Barr? syndrome accompanying the 1976 swine flu vaccination. Influenza viruses for the vaccines are grown in chick embryos, so the vaccines should not be administered to patients with chicken or egg allergies. Antibodies to a particular viral strain are long-lasting; however, the mutation rate is such that a new vaccination is advisable each year. Antiviral drugs may be administered to those for whom the vaccine is contraindicated, or who did not get immunized with enough time before an outbreak for antibodies to develop. They are 50 to 80% effective for prevention of type A influenza only.
Complications/Sequelae

The most common complication of influenza, occurring frequently in elderly patients and others with impaired immune systems, is bacterial pneumonia. This results from viral damage to the lungs' defenses, allowing proliferation of Streptococcus pneumonia, Staphylococcus aureus,?or Haemophilus influenzae bacteria. Occasionally, actual viral invasion of the alveoli may result in interstitial pneumonia, a serious disease with high mortality from lung hemorrhage and edema. Patients with underlying cardiac or pulmonary disease are at higher risk for this complication. Bronchitis and asthma may be exacerbated by influenza. Nonrespiratory complications may include pericarditis, myocarditis, myositis, rhabdomyolysis, and Reye's syndrome (particularly in children). Following influenza, fatigue may be present for up to two weeks.
Prognosis

In uncomplicated influenza the symptoms generally last one to five days, but they can last up to two weeks.
Pregnancy

Studies suggest that pregnancy may increase the risk of serious influenza complications due to decreased lung capacity, increases in heart rate and oxygen consumption, and immunologic changes. The CDC has recommended vaccination for women who will be in the second or third trimester of pregnancy during the flu season. No adverse fetal effects are known.
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