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Case 20

Case 20. Jay-R, 25 years old, married came to the OPD because of high grade fever –3 days in duration accompanied by moderate headache, nausea, body ache and non-productive cough.

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Case 20

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  1. Case 20

  2. Jay-R, 25 years old, married came to the OPD because of high grade fever –3 days in duration accompanied by moderate headache, nausea, body ache and non-productive cough. No loose bowel movement was reported. Patient took Biogesic for symptomatic treatment. Working diagnosis: Acute viral infection. Probably Influenza A

  3. What will be your treatment? Is it necessary to give antibiotics at this point in time?

  4. Symptomatic treatment • Prescribe analgesics such as paracetamol for his headache and body ache • Also tell him to take cough suppressants such as detromethorphan (over the counter) • Advise patient to drink plenty of fluids and to take rest

  5. Give Antibiotics? • No. It’s not a bacterial infection. • Working diagnosis: Acute viral infection • Clue: non-productive cough aka dry cough • Usually caused by viral infection • Verification • Have patient get CBC

  6. Note neutrophils and WBC levels • If high, most certainly bacterial • Now you can give antibiotics (amoxicillin) • Never haphazardly prescribe antibiotics • Resistance among bacteria will develop

  7. What antiviral agent/s would you give if you choose to treat Influenza A?

  8. Amantadine and Rimantadine • Mechanism of action • Blocks viral RNA uncoating of influenza A, inhibiting viral replication • Target protein M2 • Ion channel

  9. Amantadine and Rimantadine • Treatment • Reduce the symptoms of the flu and shortens the time you are sick by 1-2 days • Makes you less contagious • Useful in high risk patients who have not been vaccinated, or during epidemics

  10. Amantadine and Rimantadine • Prevention • For preventing the flu in healthy adults (Given to people who are likely exposed to the flu)

  11. Amantadine and Rimantadine • Adverse Effects • Amantadine • Mainly associated with the CNS • Minor symptoms – insomnia, dizziness, ataxia • Major side effects noted • Hallucinations, seizures • Rimantadine • Lower risk of CNS adverse effects • Since it doesn’t extensively cross blood brain barrier

  12. Newer Agents for the Flu: Neuraminidase inhibitors • MOA • Inhibits influenza neuraminidase enzyme thus virus aggregation and release • Zanamivir (Relenza) • Uses inhalation device for 5 days • Oseltamivir (Tamiflu) • Available as capsule/suspension • Must be used within 48 hours of symptoms

  13. Adverse effects • Dizziness, drowsiness • Bronchospasms rare

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