A Family Doctor's Tale - INFLUENZA

DOC I HAVE THE FLU

INFLUENZA is probably the most common illness seen by family doctors all over the world.

There are more than 2000 strains of influenza virus which can mutate every few months resulting in more strains.
Influenza A strains are more dangerous than the Influenza B strains and Influenza strain C.

In the northern hemisphere the incidence of influenza occurs during the winter season (October to March) whereas in the southern hemisphere the incidence again is higher during their winter(May to September).

The influenza virus is highly contagious and usually spread by droplets through the air. 
Patients should always avoid crowded places and keep their hands clean. 
If possible wear a mask to prevent the spread of germs.


Because of the convenience of air travel the spread of influenza is very high throughout the world.
The recent case was the 'pandemic' of H1N1 influenza (which is an A strain Influenza) declared by the WHO in 2009.


Unlike the common cold viruses, influenza viruses produces more severe symptoms which can last more than 2 weeks:


1.Fever usually above 38 centigrade
2.Body aches
3.Cough dry or productive of yellow and green phlegm
4.Tiredness
5.Headache
6.Sneezing ot blocked nose occasionally
7.Breathlessness
8.vomiting especially in young children


Usually a influenza runs its course without complications in one to two weeks.


However the more deadly influenza viruses can cause a lot of complications in the very young, very old or those with low immune system(chronic diseases, pregnant women, AIDS (A Simple Guide to AIDS)). 

Serious complications can occur like:
1.Pneumonia (infection of the lungs) which kill the very old or young patients every winter. I normally check on the lungs on every patient with influenza. 
All pneumonia cases should be treated in hospital where there is oxygen and respirators to treat breathing difficulty.

2.Bronchitis( A Simple Guide to Bronchitis) and reactivation of asthma (A Simple Guide to Asthma) attacks may also cause breathing problems. I always ask for a history of asthma or wheezing in influenza patients and check their lungs carefully.


3.Meningitis ( A Simple Guide to Meningitis) is another complication which is due to the influenza virus attacking the membranes of the spinal cord or meninges.
I always check for high fever, headache and vomiting. Any patient with stiffness of the neck should be sent to hospital for further investigation and treatment.

Less serious complications like sinusitis ( A Simple Guide to Sinusitis) and otitis media ( A Simple Guide to Otitis Media)may also aggravate the patient's recovery.
X-ray of the sinuses should be taken if necessary and the ear checked for eardrum infection.


Treatment is aimed at relieving symptoms and preventing complications.


1.Rest is the most important part of treatment. 
A rested patient will recover faster.


2.Adequate warm fluids helps to keep the mucus membranes moist to allow infected mucus to flow better and also prevent dehydration especially in children below 5 years


3.If there is any fever, headaches and pains, paracetamol can be given to relieve symptoms.


4.Oral (tablet or syrup) cough medicine may also relieve cough. Mucolytic agents may help in dissolving mucus.


5.Bronchodilators help to open the airway for the cough to expel the germs from the lungs.

6.Antibiotics and vitamin C are not helpful in relieving symptoms of the influenza. 
Antibiotics should be given if there is associated secondary bacterial infection like sinusitis.

However recently there are antiviral agents such as Tamiflu and Relenza which can cure the influenza.



Prevention is by taking yearly seasonal vaccines injections against the influenza virus especially in the very old (after 65 years), very young (below 5 years) and those with low immune system or chronic disease.


Other preventive measure against influenza is to live a healthy life style:
Proper hygienic care of the hands and body
Avoid crowded places
Well balanced diet with enough fluids
Adequate mild exercise. 
Do not do any strenuous activities during or after Influenza because of the danger of viral myocarditis.

Please note that Influenza is a very infectious viral disease which can spread quickly and kill  the young and old easily.