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Julio A. Ramirez, MD, FACP Professor of Medicine Chief, Infectious Diseases University of Louisville Louisville, Kentucky, USA Update on Influenza.

Published byAllison Scott Modified over 10 years ago

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Presentation on theme: "Julio A. Ramirez, MD, FACP Professor of Medicine Chief, Infectious Diseases University of Louisville Louisville, Kentucky, USA Update on Influenza."— Presentation transcript:

1 Julio A. Ramirez, MD, FACP Professor of Medicine Chief, Infectious Diseases University of Louisville Louisville, Kentucky, USA Update on Influenza

2 1. Influenza Research Projects 2. Influenza Clinical Syndromes 3. Influenza Pathogenesis Update on Influenza 4. Influenza Outcomes & Treatment

3 Region 1 Region 2 Region 3 Region 4 C ommunity- A cquired P neumonia O rganization C ommunity- A cquired P neumonia O rganization CAPO: International Study www.caposite.com

4 Region 1 Region 2 Region 3 Region 4 C ommunity- A cquired P neumonia O rganization C ommunity- A cquired P neumonia O rganization University of Louisville Clinical & Translational Research Support Unit CAPO: International Study www.caposite.com CAPO: 122 centers in 35 countriesCAPO database: >10,000 CAP patients

5 CAPO: International Study www.caposite.com CAPO Pneumonia International Research Network

6 CAPO: International Study www.caposite.com CAPO Pneumonia International Research Network CAPO Project Primary Aims: To evaluate current management of hospitalized patients with pneumonia To foster global research in the field of pneumonia & influenza CAPO Project Primary Aims: To evaluate current management of hospitalized patients with pneumonia To foster global research in the field of pneumonia & influenza

7 www.sips.com SIPS Study Severe Influenza Pneumonia Surveillance (SIPS) Project

8 SIPS Study www:KYflu.com

9 Severe Influenza Pneumonia Surveillance (SIPS) Project SIPS Study www:KYflu.com SIPS Project Primary Aim: To develop a tool for the surveillance, detection, and response to novel Influenza virus strains in Kentucky SIPS Project Primary Aim: To develop a tool for the surveillance, detection, and response to novel Influenza virus strains in Kentucky

10 www.retostudy.com ClinicalTrials.gov Identifier: NCT01248715 RETOS Study

11 Jefferson County, Kentucky Jefferson County location in Kentucky RETOS Study Kentucky location in the US

12 RETOS: Jefferson County, KY UofL Hospital VA Hospital Jewish Hospital Norton Hospital Suburban Hospital Baptist East Hospital Audubon Hospital Brownsboro Hospital St Mary’s Hospital

13 RETOS Study www.retosstudy.com RETOS Study Primary Aim: To evaluate clinical outcomes of hospitalized patients with influenza treated with oseltamivir at time of hospitalization RETOS Study Primary Aim: To evaluate clinical outcomes of hospitalized patients with influenza treated with oseltamivir at time of hospitalization

14 Center for Predictive Medicine

15 1. Influenza Research Projects 2. Influenza Clinical Syndromes 3. Influenza Pathogenesis Update on Influenza 4. Influenza Outcomes & Treatment

16 Middle Ear LarynxLarynx AlveoliAlveoli Maxillary Sinus TonsilsTonsils BronchiBronchi Eustachian tube Frontal Sinus Respiratory Tract Influenza: Pathogenesis

17 Middle Ear LarynxLarynx AlveoliAlveoli Maxillary Sinus TonsilsTonsils BronchiBronchi Eustachian tube Frontal Sinus Respiratory Tract Influenza: Pathogenesis

18 Middle Ear LarynxLarynx AlveoliAlveoli Maxillary Sinus TonsilsTonsils BronchiBronchi Eustachian tube Frontal Sinus Respiratory Tract Influenza virus Influenza: Pathogenesis Airborne droplets Direct contact Airborne droplets Direct contact

19 Respiratory Tract Infections (RTIs) Influenza virus RhinopharyngitisRhinopharyngitis Influenza: Pathogenesis

20 SinusitisSinusitis Respiratory Tract Infections (RTIs) Influenza virus Influenza: Pathogenesis RhinopharyngitisRhinopharyngitis

21 Respiratory Tract Infections (RTIs) OtitisOtitis Influenza virus Influenza: Pathogenesis RhinopharyngitisRhinopharyngitis SinusitisSinusitis

22 Respiratory Tract Infections (RTIs) OtitisOtitis Influenza virus BronchitisBronchitis Influenza: Pathogenesis RhinopharyngitisRhinopharyngitis SinusitisSinusitis

23 PneumoniaPneumonia BronchitisBronchitis Respiratory Tract Infections (RTIs) OtitisOtitis Influenza virus Influenza: Pathogenesis RhinopharyngitisRhinopharyngitis SinusitisSinusitis

24 PneumoniaPneumonia BronchitisBronchitis Respiratory Tract Infections (RTIs) OtitisOtitis Influenza: Pathogenesis SevereInfluenzaSevereInfluenza RhinopharyngitisRhinopharyngitis SinusitisSinusitis

25 OtitisOtitis Severe Respiratory Tract Infections (RTIs) BronchitisBronchitis Acute Bronchitis Acute Exacerbation of COPD 1 2 Influenza: Pathogenesis SevereInfluenzaSevereInfluenza RhinopharyngitisRhinopharyngitis SinusitisSinusitis PneumoniaPneumonia

26 OtitisOtitis PneumoniaPneumonia Severe Respiratory Tract Infections (RTIs) Community- Acquired Pneumonia Pneumonia HCAPHCAP 3 4 BronchitisBronchitis Acute Bronchitis Acute Exacerbation of COPD 1 2 Influenza: Pathogenesis SevereInfluenzaSevereInfluenza RhinopharyngitisRhinopharyngitis SinusitisSinusitis

27 RETOS Study www.retosstudy.com Total of 1,256 patients hospitalized with LRTIs Total of 1,256 patients hospitalized with LRTIs

28 Influenza: Pathogenesis Severe LRTIs in Jefferson County Total of 1,256 patients

29 Influenza: Pathogenesis Severe LRTIs in Jefferson County Influenza A Influenza A RSV RSV Parainfluenza Parainfluenza Coronavirus Coronavirus Metapneumovirus Metapneumovirus Rinovirus Rinovirus Adenovirus Adenovirus Seasonal H1 or H3 Seasonal H1 or H3 A and B A and B 1, 2, 3, and 4 1, 2, 3, and 4 Group 1, 2, and SARS Group 1, 2, and SARS Influenza B Influenza B RespiratoryViralPanel

30 Pneumonia: Viral Etiology Influenza: Pathogenesis

31 Case 1: 82 year-old WM Case 2: 58 year-old WF Case 3: 71 year-old WF Case 4: 38 year-old WF Pneumonia: Viral Etiology

32 Influenza: Pathogenesis Case 1: 82 year-old WM Case 2: 58 year-old WF Case 3: 71 year-old WF Case 4: 38 year-old WF Respiratory Syncytial Virus A Adenovirus Parainfluenza Virus 3 Influenza A H1N1 Pneumonia: Viral Etiology

33 1. Influenza Research Projects 2. Influenza Clinical Syndromes 3. Influenza Pathogenesis Update on Influenza 4. Influenza Outcomes & Treatment

34 Severe Influenza Pneumonia Surveillance (SIPS) Project Nine clinical isolates of Influenza A H1N1 Influenza: Pathogenesis

35 2009 H1N1 Influenza A Virus Influenza: Pathogenesis

36 2009 H1N1 Influenza A Virus Influenza: Pathogenesis Viral Virulence LowLowHighHigh 2009 H1N1 KY/180 2009 H1N1 KY/136

37 CAP: Viral Etiology 2009 H1N1 Virus Infection: Viral Virulence & Poor Outcomes 2009 H1N1 KY/136 2009 H1N1 KY/180 No Infection Mortality Day 6 Lung Day 6 0% DBA/2 Mice

38 CAP: Viral Etiology 2009 H1N1 Virus Infection: Viral Virulence & Poor Outcomes 2009 H1N1 KY/136 2009 H1N1 KY/180 No Infection Mortality Day 6 Lung Day 6 0% DBA/2 Mice

39 CAP: Viral Etiology 2009 H1N1 Virus Infection: Viral Virulence & Poor Outcomes 2009 H1N1 KY/136 2009 H1N1 KY/180 No Infection Mortality Day 6 Lung Day 6 0% 100% DBA/2 Mice

40 CAP: Viral Etiology 2009 H1N1 Virus Infection: Viral Virulence & Poor Outcomes 2009 H1N1 KY/136 2009 H1N1 KY/180 No Infection Mortality Day 6 Lung Day 6 0% 100% DBA/2 Mice

41 1. Influenza Research Projects 2. Influenza Clinical Syndromes 3. Influenza Pathogenesis Update on Influenza 4. Influenza Outcomes & Treatment

42 Influenza: Treatment Influenza Antiviral Medications: Summary for Clinicians Initiation of antiviral treatment as early as possible is recommended for hospitalized patients Antiviral treatment might be effective in reducing morbidity and mortality in hospitalized patients even if treatment is not started until more than 48 hours after onset of illness Influenza Antiviral Medications: Summary for Clinicians Initiation of antiviral treatment as early as possible is recommended for hospitalized patients Antiviral treatment might be effective in reducing morbidity and mortality in hospitalized patients even if treatment is not started until more than 48 hours after onset of illness

43 Influenza: Treatment

44

45

46 RETOS Study www.retosstudy.com Total of 1,256 patients hospitalized with LRTIs Total of 1,256 patients hospitalized with LRTIs

47 Influenza: Treatment Impact of Oseltamivir on Clinical Outcomes of Hospitalized Patients with Influenza Pneumonia Patients: 77 Patients: 35 Oseltamivir: Yes Oseltamivir: No Patients hospitalized with Influenza CAP: 112 Patients hospitalized with CAP: 801 Patients hospitalized with LRTIs: 1,256

48 Impact of Oseltamivir on Clinical Outcomes of Hospitalized Patients with Influenza Pneumonia Time to Clinical Stability Duration of Hospitalization Influenza: Treatment

49 Impact of Oseltamivir on Clinical Outcomes of Hospitalized Patients with Influenza Pneumonia Time to Clinical Stability Duration of Hospitalization Influenza: Treatment

50 Impact of Oseltamivir on Clinical Outcomes of Hospitalized Patients with Influenza Pneumonia Time to Clinical Stability Duration of Hospitalization Influenza: Treatment

51 Impact of Oseltamivir on Clinical Outcomes of Hospitalized Patients with Influenza Pneumonia Time to Clinical Stability Duration of Hospitalization Oseltamivir has no effect on Clinical Outcomes Influenza: Treatment

52 1. Influenza Research Projects 2. Influenza Clinical Syndromes 3. Influenza Pathogenesis Update on Influenza 4. Influenza Outcomes & Treatment

53

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