8998 H1N1,AIDS,Gynecology

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It might be helpful to you to know that referring to a virus as “H1N1″ is actually ambiguous. There are two H1N1 viruses that affect humans. One is the seasonal H1N1 virus and the other is the novel H1N1 virus. Although both viral capsules have 1 hemagglutinin protein (HA) and 1 neurominidase protein (NA), these HNs are not the same and all H1s are not the same either. There IS a genetic difference. What that difference is can depend on what research you subscribe to. One line of thought is that the novel virus is a variant strain of the seasonal virus. This makes sense to me on many levels. Apparently, the structure of the capsule has changed….undergone some sort of structural mutation. It’s not shaped the same as that of seasonal H1. There’s also gene reassortment to consider which could make novel H1 a sort of….hybrid virus, I suppose.
As for clinical s/s, the distinguishing features are N/V & diarrhea. With seasonal H1N1, these sxs present in young children and rarely in older kids, teens & adults. But with novel H1N1 flu, they tend to be more prevalent in all ages. This means, if a pt., oh say in their early 20s, presents with the usual viral infection symptoms w/respiratory component, it happens to be flu season AND this pt. reports N/V and/or diarrhea, I’d suspect novel H1N1 rather than the seasonal HN virus and would make a presumptive dx of novel H1N1 influenza. And I would do this without cultures or RT-PCR. Rapid tests can distinguish between types A & B but aren’t reliable in differentiating between seasonal and novel. Sometimes you just have to make a differential based on the presentation and a hunch. Other than N/V & diarrhea, the pathophys is essentially the same because these are both H1N1 viruses. Now if the same pt., same presentation, came in during a time of low flu prevalence, I might go ahead and order the RT-PCR to get a definitive.
On to flu-related comps. Comps are mostly confined to those with the pre-existing conditions that predispose them to flu-related complications. Obesity, pregnancy, cardiac conditions, chronic respiratory conditions, diabetes. Even the condition of being very young or very old can mean an insufficient immune system and remember that an infant’s airway is small. No room for error. Other conditions one might not think of are poor overall health, immune system impairment/compromise due to a medical or genetic condition, poor diet/lifestyle. Think about the homeless & those who live in abject poverty. Poor diet, little or no health care. Having a concurrent respiratory infection predisposes one to comps.
Complications include (number 1) pneumonia (primary viral and secondary bacterial), respiratory distress & failure which could lead to hypoxic (or anoxic) encephalopathy. Other comps include otitis media, sinusitis, dehydration and it’s sequellae and a progressive worsening of co-morbidities.
As to neurominidase inhibitors, amantadine and rimantadin work against type A viruses but not type B. Zanamivir (Relenza) and oseltamivir Tamiflu) are effective against both types. It bears remembering that these antivirals do not cure flu and shorten the duration for by only 1-2 days. By rights, antiviral therapy should be reserved for at-risk pts. and not handed out like candy just because non-at-risk pts. demand it as if it were the cure for for world hunger. We’re already encountering oseltamvir-resistant virus. Look at what happened with methicillin, vanco, bacitracin and MDR. Perhaps we could use some hemagglutinin inhibitors, as well, in the battle against influenza. I understand that viable inhibitors are being studied.
You could get much more data and much more in-depth data from a virologist. I know you have access to at least one. It might be worth a shot.
And the very best of luck on your boards!! I hope you pass all 3 steps with flying colors!