Chapter 6

Chapter 6

"I’ve got the flu. What can I do?"

Friday night’s concert was great. Even though it was November and cold outside, thousands had jammed together to hear "Alcamo and the Mutants," the latest singing rage. Jim and his friends left the Civic Center hoarse from yelling. They stopped at their usual hangout, Paul’s Pizza Palace, and rejoined some of their friends. The ice-cold Coke and piping-hot sausage and mushroom pizza tasted wonderful. Saturday, Jim finally got up at 1 p.m. The rest of Saturday was a blur. Sunday evening was devoted to finishing up some homework and studying for his Principles of Biology class. There was a big lab exam coming up on Thursday.

On Monday, the alarm went off at 6 a.m. On this day, the alarm sounded like a giant gong inside Jim’s head. Turning on the light nearly blinded him and added to the pain of his pounding head. Jim’s throat was dry and had a tickling sensation. When he coughed, it was a dry, sometimes raspy, cough. Jim started to shiver and realized that most of his muscles ached. He felt hot and was exhausted. "What’s going on?" groaned Jim. "What did I eat to cause this feeling?" Jim tried to stand up but felt like he had been beaten with a baseball bat. He fell back into bed and immediately regretted that move. His head was pounding like the drummer on Friday night. Only this time, his head was the drum.

A. Be Sure it’s Really the Flu

Jim is showing most of the classic symptoms of influenza – the "flu." Did you recognize the symptoms? Headache, fever, chills, dry cough, tiredness and really achy muscles are the starting symptoms. There are many diseases that cause flu-like symptoms. Some of these diseases are bacterial, some are fungal and some are viral. If a person can get up and go to work or school, it is very unlikely that he or she has the flu. Jim doesn’t sound like he is going anywhere very soon. Jim wondered if he had eaten something to cause these symptoms. People sometimes use the term "stomach flu." This condition can be caused by one of several viruses. The rotavirus causes "stomach flu" and occurs during the same time of the year as the influenza virus. Other enteric (intestinal) viruses and the Norwalk virus all cause "stomach flu." Norwalk viruses cause a vomiting disease during the winter and all "stomach flu" viruses cause vomiting and/or diarrhea. So far this has not been added to Jim’s list of symptoms. Another disease sometimes called stomach flu is gastroenteritis and is usually caused by bacteria. Stomach flu is sometimes called viral gastroenteritis.

Could Jim have a cold or a strep throat? Remember the table of comparisons shown in Chapter ???. Cold symptoms normally include stuffy, runny noses, sneezing and sore throat and cough. Symptoms of a cold usually do not include a fever or body aches. Jim does not have these symptoms. Strep throat symptoms include a high fever, headache, tiredness and coughing. Strep throat is caused by a bacterium of the genus Streptococcus. Jim certainly has those symptoms. But strep throat victims also have swollen lymph glands and a red, raw appearance to the back of the throat. If Jim could get to the doctor he could find out which disease he has. There are a number of rapid tests that can be done in the doctor’s office for identification of strep infections. Since there are a high number of cases of flu in the community, Jim’s doctor will probably suggest that Jim does in fact have the flu. A quick call to some of his concert friends showed that three of them had the same symptoms as Jim. Their doctors had also diagnosed their illnesses as the flu.

B. They’ve Got the Flu

It seems that almost all doctors agree what you should do when the flu catches you. First, be sure to get plenty of bed rest. Don’t try to be a hero and drag yourself to work or school. You are a menace in a number of ways – going to work or school, while you are there, and on your way home. You could be sleepy while driving or while at work or school. You also could be spreading the joys of influenza to your work or school mates. Second, drink plenty of fluids. Try to drink water and not alcoholic or caffeinated drinks. Third, take over-the-counter medications to relieve the major symptoms. Remember that these medications will reduce your discomfort. They will not treat the viral infection itself. Most physicians will recommend acetominophen-based products to relieve the fever and aches. The fever may last from 2-5 days. These products, such as Tylenol, are less likely to irritate the stomach. Aspirin and aspirin-based products sometimes irritate the stomach lining. They may play a role in the development of a rare liver and central nervous system condition known as Reye’s* Syndrome (see Box). This condition shows up most frequently in children under 18 years of age. It has been shown to cause vomiting, convulsions, brain damage and even death. If your symptoms include congestion, coughing and a runny nose, you may also take decongestants and antihistamines. There are a number of over-the-counter flu remedies that contain both of these ingredients.

(add Table - Symptom Relief for Colds and the Flu http://lungusa.org/diseases/c&f02/cftable2.html)

C. Treatment Regimes – Prescription Drugs

It is important that you see your doctor within 48 hours of having noticed the symptoms. There are some new anti-viral drugs available that will reduce both the severity and length of the disease. These drugs must be given within 48 hours for maximum effectiveness and require a doctor’s prescription.

The first of these drugs is amantidine. It goes by the name of Symmetrel or Lysovir. The second drug is known as rimantadine or Flumadine. Both of these drugs work only on Type A influenza and will not work on Types B or C. Flumadine is less toxic. Person with cases of uncomplicated Type A influenza may be given amantadine for 5 days. The usual dosage is 200 mg. Rimantadine is usually given in 100 mg doses twice a day for 5 days. Recently, Type A viruses resistant to both of these drugs have been found, usually in young children treated with the drug.

Two other drugs, recently developed, can be used to treat both Types A and B influenza. These drugs zanamivir (Relenza) and oseltamivir (Tamiflu) are part of a group of drugs that attack a different site on the virus. You may wish to go back to Chapter ?? and review the structure of the influenza virus. Relenza and Tamiflu attack and inhibit the enzyme neuraminidase which is a prominent part of the viral coat. Relenza is available in spray form only while Tamiflu can be taken orally. Both have been shown to have very few clinical side effects. Relenza can be used as a treatment for those 12 and older. Tamiflu is used as a treatment for those 18 and older. Tamiflu can be given to those 13 years of age or older to prevent coming down with flu. Relenza is not used as a preventative. Tamiflu is currently the most widely prescribed antiviral for influenza. Unfortunately, it is also more expensive than Symmetrel and Flumadine.

(add Table - Treatment for Influenza
http://lungusa.org/diseases/c&f02/cftable1.html
)

Please don’t call you doctor begging for an antibiotic unless you know you are dealing with a bacterial infection. Antibiotics do not work against viruses.

D. You and Your Doctor

It is important to see your doctor when symptoms first appear. Only in this way can a strep infection be ruled out. If it is a strep infection, appropriate antibiotics can be prescribed. If it is the flu, the doctor may prescribe one of the previously mentioned antiviral medications. Sometimes infection with the influenza virus can be complicated with other viruses, bacteria or fungi. If you become breathless or if you begin to slip in and out of consciousness, CALL THE DOCTOR. If you become confused or delirious, CALL THE DOCTOR. As is true with most diseases, you have a better chance of recovering completely and rapidly if you take positive action to treat the disease and its symptoms.

Could Jim have prevented getting the flu? What could he have done? What should he do in the future? These are some of the questions that will be addressed in the next chapter.

Interest Box

On May 11th 1997 a young boy in Hong Kong was having difficulty breathing. This three-year-old was hospitalized on the 15th of May and diagnosed as having pneumonia and Reye’s Syndrome.

One of the problems associated with influenza is the damage to lung tissue. The tissue becomes swollen and inflamed. This damage is usually slight and heals within a few weeks. The immune system of a young child often responds slowly to the rapid growth of the virus.

Pneumonia is an inflammation of the lungs caused by different viruses or bacteria. Reye’s Syndrome affects the brain and liver of a child recovering from a viral infection like influenza. Nausea and vomiting are followed by confusion and becoming delirious. As the liver breaks down the chemistry of the blood begins to change. Most victims of Reye’s Syndrome or live with some degree of brain damage. This syndrome is associated with taking aspirin-based products. therefore, aspirin should NEVER be given to children under 12 years of age suffering from flu-like symptoms.

On May 21, 1997, the young boy died. It was reported that he had died from complications of the flu. He was the first victim in the 1997 group of individuals who died from a strain of influenza found in chickens. This was the first time that this strain showed up in humans. By November of 1997, more cases appeared and the world was made aware of a new type of flu.

National Reye's Syndrome Foundation
http://www.reyessyndrome.org/

Reye's Syndrome Hub
http://www.knowdeep.org/reye/