IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

CORE PRINCIPLES IN THE MANAGEMENT OF IMMUNODEFICIENCY

Clinical manifestations, prevention, and treatment of influenza

On the first day of Influenza onset, patients typically experience a sharp Temperature spike up to 38–40 °C, headache, nasal congestion, sore throat, potential lacrimation, eye irritation, and joint pain. Coughing may manifest on either the first or second day of the illness. Without timely medical intervention, symptoms tend to escalate rapidly. Therefore, it is critical to consult a physician at the very first sign of these symptoms.

Once the presence of the influenza virus is confirmed and proper Treatment is initiated, the patient's condition generally begins to improve by the 2nd to 3rd day. Clinical practice demonstrates that with prompt medical attention, recovery is typically achieved within 7–9 days.

Phases of disease progression. The virus enters The Human Body via airborne droplets or through direct contact (handshakes, contaminated surfaces, influenza A(H1N1)). Upon infection, it targets the mucous membrane of the Upper Respiratory Tract. Subsequently, the virus descends the respiratory tract to infect pulmonary Tissues, after which the aforementioned symptoms begin to manifest.

However, these symptoms may remain latent for 24 to 48 hours post-infection. This latency is precisely what makes the influenza virus so dangerous, as infected individuals unknowingly transmit the virus to others while feeling entirely healthy.

The subsequent phase is characterized by viremia, wherein the virus enters the bloodstream and affects the Lungs.

Pneumonia is the most frequent cause of mortality resulting from influenza infection. Pulmonary involvement is distinguished by persistent coughing and high fever. Naturally, symptom severity and treatment duration depend on the patient's baseline immune status.

Identification of the viral strain is exclusively possible through Laboratory Diagnostics.

A confirmed case of influenza infection is defined as an acute human illness with a Diagnosis verified through specialized Laboratory tests.

Influenza virus infection is identified if:

1. An individual contracts an acute respiratory illness after close contact with a patient diagnosed with confirmed influenza.

2. An individual contracts an acute respiratory illness after close contact with infected animals (characteristic of the California influenza strain A(H1N1)).

3. An individual contracts an acute respiratory illness after traveling to regions with confirmed influenza cases within the 7 days prior to symptom onset.

General influenza Prevention measures:

- avoid close contact with individuals who appear ill, present with fever, or are coughing;

- wash hands thoroughly and frequently with soap and Water;

- maintain a healthy lifestyle, including adequate Sleep, nutritious diet, and physical activity.

Vaccination. According to the WHO and numerous leading researchers, vaccination represents the most effective defense against all infectious diseases. Influenza immunization remains the primary line of defense in our fight against this condition. Influenza vaccination is typically administered between October and November. Annual immunization is recommended, as previous years' Vaccines have proven less effective against current influenza strains. It is also important to remember that Immunity to influenza develops within two weeks post-vaccination. WHO experts continuously monitor antigenic shifts in Viruses, which helps update vaccines for more effective protection against emerging influenza strains.

Currently, split vaccines—disrupted virus vaccines from which toxins have been removed—are the most effective and safe options; such vaccines contain 4 Antigens representing each of the three influenza virus types. The prophylactic efficacy of this vaccine Class ranges from 75 to 96%. Classic Examples of medications in this category include Influvac (Netherlands) and Vaxigrip (Russia).

Depending on various conditions, vaccination provides a 70–90% guarantee against contracting influenza. Vaccinating 80% of a cohort (schoolchildren, company employees, enterprise staff) can reduce influenza morbidity rates to near zero. Furthermore, influenza vaccination reduces the incidence of all acute respiratory infections by 50–60%.

The notion that vaccines overload or entirely suppress The Immune System is erroneous. This is incorrect if only because the fundamental purpose of vaccination is to stimulate immunity, rather than suppress it. Moreover, every day the human body encounters thousands of antigens through food, Respiration, and dermal absorption, not to mention endogenous antigens generated by the body itself (aberrant or redundant Cells). The Introduction of 6, 12, or even 15 additional vaccine antigens is negligible and certainly does not overload the immune system.

Antiviral agents. Alongside vaccines, the arsenal of prophylactic and therapeutic agents includes antivirals: groprinosin and arbidol exert immunomodulatory, interferonogenic, and antioxidant effects, active against Influenza Viruses A and B; ribavirin is a synthetic nucleoside analogue with a broad spectrum of activity against various DNA and RNA viruses.

Oseltamivir (Tamiflu) is a selective neuraminidase inhibitor targeting influenza viruses A and B. It is indicated for the treatment of influenza in adults and children aged 12 and older. Each capsule contains 75 mg of oseltamivir. For influenza treatment, Tamiflu is prescribed at a dose of 75 mg twice daily for 5 days.

Interferon preparations. Natural leukinferon and recombinant interferons (viferon, grippferon) administered intranasally play a crucial role in the prevention of influenza and other viral infections. All interferon preparations induce the cellular synthesis of Proteins that provide antiviral and immunomodulatory effects aimed at clearing cells of viruses.

Interferon Inducers. Interferon inducers are also widely used for the prevention of viral diseases: cycloferon (neovir) 12.5% solution 2 ml i.m. twice a week for 7 doses, or amiksin 1 tab. 0.125 g according to the scheme: 3 tabs. at once, then 1 tab. every other day for 7 doses; amizon 1 tab. 0.25 g (same scheme), activating The production of various types of interferon by body cells: alpha, beta, and gamma interferons. Enhanced production of endogenous interferon boosts the body's antiviral defense and provides an immunomodulatory effect.

Immunoactive drugs from various groups that strengthen the immune system: lycopid, polyoxidonium, IRS-19, imudon, bronchomunal, ribomunyl, immunofan.

Phytotherapy (immunal) and The Use of homeopathic remedies (gripp-heel, angin-heel, aflubin).

Methods of nonspecific immunoprophylaxis during the influenza epidemic period include:

- administration of interferon (laferon, human leukocyte interferon) or its inducers (neovir, amiksin, cycloferon);

- use of bacterial immunomodulators (IRS-19, ribomunyl, bronchomunal) for preseason immunostimulation;

- Chemoprophylaxis — taking isoprinosine (groprinosin), arbidol, or amiksin throughout the entire epidemic period;

- general strengthening Procedures (hardening, acupuncture, vitamin therapy, adaptogens [echinacea, eleutherococcus, ginseng]) are of secondary importance.

Medical prevention of influenza:

1) amiksin 0.125 g (1 tab.) once a week for 6 weeks;

2) arbidol 0.2 g (2 tabs.) once a day for 10–14 days;

3) anaferon 1 tab. once a day 30 minutes before meals or 30 minutes after meals, allowed to dissolve in the Mouth, for 1–3 months during the epidemic season.

4) Vitamin C 1 g per day;

5) adaptogenic drugs: tinctures of Rhodiola rosea, eleutherococcus, schisandra, 10 drops 3 times a day after meals, as well as cycloferon 1 tab. once a day 3 times a week or alpha-interferon nasal ointment for 3 weeks to 1 month.

6) kagocel is prescribed in 7-day cycles (2 days at 2 tablets per day, then a 5-day break, followed by another 2 days at 2 tablets per day) for 1 month.

Pregnant women (starting from the 14th week of Pregnancy) can use alpha-interferon suppositories containing 150,000 IU twice daily for five days.

Emergency chemoprophylaxis of influenza:

- oseltamivir (tamiflu) — 75 mg twice daily for 5–7 days;

- groprinosin — has direct antiviral and immunostimulatory effects. Taken during the peak of the disease for prophylactic purposes at 0.5 g (1 tab.) 3 times a day for 7–10 days;

- arbidol — same MECHANISM OF ACTION, taken during the peak of the disease for prophylactic purposes at 0.2 g (2 tabs. of 0.1 g) once a day for 10–14 days.

Etiotropic therapy for influenza in the event of illness:

- oseltamivir (tamiflu) — 75 mg twice daily for 5 days;

- groprinosin — taken starting from the first day of influenza for therapeutic purposes, preferably after meals; the tablet may be crushed, at 1 g (2 tabs. of 500 mg, daily dose 50 mg/kg of body weight) 3–4 times a day for 5–7 days. Treatment is continued for another 1–2 days after symptoms disappear. In severe cases, the daily dose can be doubled to 100 mg/kg;

- arbidol — same mechanism of action, taken starting from the first day of influenza at 0.2 g (2 tabs. of 0.1 g) 4 times a day for 5 days;

- amixin 0.125 g (1 tab.) once a day after meals, on days 1, 2, and 4 of treatment;

- anaferon: 1 tab. every 30 minutes for the first 2 hours, then 3 times a day for the first 24 hours, and from the second day onward, 1 tab. 3 times a day until complete recovery.

Vitamin therapy stimulates humoral and cellular immune responses.

Treatment of mild cases of influenza virus-induced viral pneumonia with antiviral drugs

1) Arbidol 0.2 (2 tabs.) 4 times a day after meals for 7–10 days.

2) Interferon-alpha or gamma 1 million IU intramuscularly daily for 5 days:

3) Thiotriazoline 40 mg (2 ml) intravenously (bolus or infusion) once a day for 10 days.

4) Ascorbic acid 1 g/day for 5 days.

Arbidol should be taken 4 times a day, 2 tablets every 6 hours, for 7–10 days.

Additionally, as an alternative regimen, combining alpha- and gamma-interferons is recommended, taking them 2 to 6 times a day for 10 days. After a one-week break, the same treatment course is repeated.

For the treatment of pregnant women (starting from the 14th week of pregnancy), interferon-alpha suppositories can be used at 500,000 IU twice a day (total daily dose of 1 million IU) for five days.

Treatment of moderate and severe cases of viral pneumonia

In the treatment of moderately severe influenza, a combination of kagocel and arbidol is recommended.

On the first day of illness, kagocel should be taken as two tablets 3 times a day, and for the next three days, one tablet 3 times a day.

Arbidol is taken 4 times a day, two tablets every 6 hours, for 7–10 days.

Administer alpha- and gamma-interferon according to the regimen described above.

Ingavirin can also be used at a daily dose of 90 mg once a day for five days, alongside Tamiflu at 75 mg twice a day for five days. These medications must be taken During the first days of illness.

For the treatment of pregnant women (starting from the 14th week of pregnancy), alpha-interferon suppositories should be used at 500,000 IU twice a day for five days. This is followed by maintenance therapy at 150,000 IU twice a day, 2 times a week, for 3 weeks.

Guidelines for the treatment of patients with severe influenza complicated by pneumonia, in the presence of pronounced leukocytosis accompanied by toxic granulation of neutrophils:

1) interferon-alpha and beta 1 million IU intramuscularly once a day for 5 days;

2) intravenous IMMUNOGLOBULINS (IVIG) are safe regarding the transmission of VIRAL INFECTIONS AND contain a sufficient amount of IgG responsible for virus neutralization, with Fc-fragment activity. IVIG is administered at a daily dose of 400 mg/kg via IV infusion at 1 ml/kg/h every other day for 3 doses.

Intraglobin is used—an IVIG containing 50 mg of IgG and about 2.5 mg of IgA per 1 ml.

Pentaglobin is an IVIG enriched with IgM, containing: IgM 6 mg, IgG 38 mg, and IgA 6 mg per 1 ml. For adults, it is administered at 0.4 ml/kg/h, then 0.2 ml/kg up to 15 ml/kg/h for 72 hours (5 ml/kg for 3 days); if necessary, a second course is prescribed. Octagam is an IVIG containing 50 mg of Plasma Proteins per 1 ml, of which 95% is IgG, less than 100 mcg is IgA, and less than 100 mcg is IgM. It is close to native plasma IgG, and all IgG subclasses are present.

3) normal human immunoglobulin for intramuscular use is prescribed at 6 ml (2 ampoules) every other day for 3 doses;

4) prednisolone 60–90 mg via IV infusion and orally in tablets daily for 3 days, followed by a gradual dose reduction and discontinuation of the drug;

5) Ceftriaxone 1.0 IV or intramuscularly for 5-7 days in accordance with the Order of the Ministry of Health of Ukraine No. 122.