NURS 5461 INFECTIOUS DISEASE—PART II EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A++
Human Influenza
appears in antigen types A and B; mutations produce new strains each flu season, In
the elderly, influenza often leads to pneumonia [5th leading cause of death in older
population]- 85% of those vaccinated develop immunity
Influenza: Prevention and Screening
85% of those vaccinated develop immunity. Amantadine [Symmetrel] or Rimantadine
[Flumadine] given after exposure to influenza A • Oseltamivir [Tamiflu] or Zanamivir
[Relenza] given after exposure to influenza B
antigenic drift
Human influenza H1 and H3 continuously
undergo variability or "antigenic drift"
- This allows new variants to evade pre-existing
humoral immunity and cause interpandemic
outbreaks
"Antigenic shift"
recombination of RNA, thus resulting in the generation of a "reassorted" virus with novel
surface proteins to which there is little population immunity
, Avian Influenza
Avian Influenza H5N1 -These viruses have >50% mortality in humans - In addition to
poultry and humans, H5N1 appears to have extended its host range to domestic cats,
where it is 100% fatal
others (- H9N2 - H7N7)
Clinical Features
In patients 12 years and older - Avian H5N1 • Fever; upper respiratory symptoms;
pneumonia; GI symptoms [diarrhea]; elevated serum transferases; pancytopenia
Avian H7N7 • Preference for conjunctival epithelium
Diagnosis
Most patients with H5N1 give a history of recent exposure to dead or ill poultry • Do a
comprehensive travel and epidemiological history
Hemagglutination RT-PCR [reverse transcriptase polymerase chain reaction] assay or •
Viral culture of aspirated secretions obtained within 72 hours of onset of symptoms -
Nasopharyngeal aspirate [use appropriate bioprecautions]
Treatment
• H5N1 viruses are resistant to Amantadine and Rimantadine, but susceptible to
Neuraminidase inhibitors Oseltamivir (Tamiflu); Zanamivir
Common/life threatening infections in the elderly
- Bacterial Pneumonia and Influenza - Urinary Tract Infection [most common] - Skin
Infections [cellulitis] - Methicillin-resistant Staphylococcus aureus [MRSA] -
Vancomycin-resistant Enterococcus [VRE] - Sepsis d/t UTI
Other important infections in the elderly
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A++
Human Influenza
appears in antigen types A and B; mutations produce new strains each flu season, In
the elderly, influenza often leads to pneumonia [5th leading cause of death in older
population]- 85% of those vaccinated develop immunity
Influenza: Prevention and Screening
85% of those vaccinated develop immunity. Amantadine [Symmetrel] or Rimantadine
[Flumadine] given after exposure to influenza A • Oseltamivir [Tamiflu] or Zanamivir
[Relenza] given after exposure to influenza B
antigenic drift
Human influenza H1 and H3 continuously
undergo variability or "antigenic drift"
- This allows new variants to evade pre-existing
humoral immunity and cause interpandemic
outbreaks
"Antigenic shift"
recombination of RNA, thus resulting in the generation of a "reassorted" virus with novel
surface proteins to which there is little population immunity
, Avian Influenza
Avian Influenza H5N1 -These viruses have >50% mortality in humans - In addition to
poultry and humans, H5N1 appears to have extended its host range to domestic cats,
where it is 100% fatal
others (- H9N2 - H7N7)
Clinical Features
In patients 12 years and older - Avian H5N1 • Fever; upper respiratory symptoms;
pneumonia; GI symptoms [diarrhea]; elevated serum transferases; pancytopenia
Avian H7N7 • Preference for conjunctival epithelium
Diagnosis
Most patients with H5N1 give a history of recent exposure to dead or ill poultry • Do a
comprehensive travel and epidemiological history
Hemagglutination RT-PCR [reverse transcriptase polymerase chain reaction] assay or •
Viral culture of aspirated secretions obtained within 72 hours of onset of symptoms -
Nasopharyngeal aspirate [use appropriate bioprecautions]
Treatment
• H5N1 viruses are resistant to Amantadine and Rimantadine, but susceptible to
Neuraminidase inhibitors Oseltamivir (Tamiflu); Zanamivir
Common/life threatening infections in the elderly
- Bacterial Pneumonia and Influenza - Urinary Tract Infection [most common] - Skin
Infections [cellulitis] - Methicillin-resistant Staphylococcus aureus [MRSA] -
Vancomycin-resistant Enterococcus [VRE] - Sepsis d/t UTI
Other important infections in the elderly
