Chapter 84 : Influenza Viruses

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Each year, influenza viruses are a major cause of febrile respiratory illness and mortality. Two patterns of infection occur in temperate climates: seasonal influenza, which is associated with annual epidemics, and pandemic influenza. Seasonal influenza is caused by influenza type A or B viruses, while pandemics are caused only by influenza type A strains. Avian strains, including A/H5N1 and A/H7N9 viruses, are a potential source of pandemic viruses. Circulation of influenza in a community should be suspected when school or work absenteeism increases in association with increases in febrile respiratory illness. Molecular assays, including real-time reverse transcriptase PCR (RT-PCR), have become the gold standard for influenza diagnosis. Rapid influenza diagnostic tests (RIDTs) are commonly used point-of-care assays that can provide results in less than 30 minutes. Although these assays have good specificity (greater than 90%), their low sensitivity means that a negative result does not exclude influenza as a diagnosis. Immunofluorescence is another antigen detection method, and it may be combined with culture to identify infection 24 to 48 hours after sample collection. Serodiagnostic methods are used in epidemiological studies but are not generally useful in the management of acute illness. Two classes of antiviral drugs, adamantanes and neuraminidase inhibitors, are licensed for treatment of acute influenza. Resistance to these drugs may be present in circulating strains or may develop during therapy. Genotypic and phenotypic methods are available to identify resistant strains.

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84
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Influenza virus-infected MDCK cells. (A) Cytopathic changes. (B) Hemadsorption with guinea pig red blood cells. Red blood cells adsorb to both infected cells (black arrows) and the plastic previously occupied by infected cells and where residual hemagglutinin protein is still present (white arrowheads). doi:10.1128/9781555817381.ch84.f1

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84
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Generic image for table

Commercially available kits for detection of influenza A or B viruses by fluorescent antibody staining

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84
Generic image for table

Commercially available rapid influenza diagnostic test kits for rapid (≤30 min) detection of influenza A or B virus

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84
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Commercially available and selected other molecular detection assays for influenza viruses .

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84
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Methods to identify and characterize influenza virus isolates

Citation: Atmar R, Lindstrom S. 2015. Influenza Viruses, p 1470-1486. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch84

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