tetano
Editor, Senior Moderator
Curr Opin Crit Care. 2019 Jul 15. doi: 10.1097/MCC.0000000000000638. [Epub ahead of print]
[h=1]Severe influenza: overview in critically ill patients.[/h] Sarda C[SUP]1[/SUP], Palma P[SUP]2,[/SUP][SUP]3[/SUP], Rello J[SUP]4[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]PURPOSE OF REVIEW:[/h] Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.
[h=4]RECENT FINDINGS:[/h] Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.
[h=4]SUMMARY:[/h] The present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.
PMID: 31313681 DOI: 10.1097/MCC.0000000000000638
[h=1]Severe influenza: overview in critically ill patients.[/h] Sarda C[SUP]1[/SUP], Palma P[SUP]2,[/SUP][SUP]3[/SUP], Rello J[SUP]4[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]PURPOSE OF REVIEW:[/h] Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.
[h=4]RECENT FINDINGS:[/h] Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.
[h=4]SUMMARY:[/h] The present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.
PMID: 31313681 DOI: 10.1097/MCC.0000000000000638