Colds and Influenza

A pandemic is defined as an epidemic that affects just about all people, and causes severe illness (and loss of life) during a period of one to two years. The influenza pandemic of 1918-1919 almost certainly rates as the greatest pandemic of all time. It affected people all around the World, from the Pacific (20% of the population of Western Samoa died) to Africa (5% of the population of Ghana died) to the USA (more than half a million Americans died). Two graphic accounts written at the time illustrate both the extent and rapidity of its effects. The first is taken from a letter written by a young physician at an army camp near Boston, Massachusetts  

This letter was printed in the British Medical Journal (December 1979), just a few months after the publication of a letter from C. Langton Hewer, who 

The high mortality associated with this pandemic was primarily due to the pneumonia, which so often followed the initial infection. This was sometimes caused by the influenza virus itself, but was more often due to the bacterium Streptococcus pyogenes. This invaded the already damaged lungs and produced a fulminating inflammatory condition, which led to respiratory collapse and death. With the advent of the sulfonamides in 1935, and subsequently, the penicillins and other antibiotics from 1945, the likelihood of such a high mortality rate from bacterial pneumonia in future pandemics was much reduced. 

Historically, influenza has probably always afflicted mankind. Similar viruses affect domestic animals and various epidemics of catarrhal fever were associated with epidemics of horse colds. The close association between humans and horses in previous centuries may have allowed a vertical transmission of influenza from horse to man. However, there is convincing evidence that a similar transmission can occur from the pig (swine flu) to man, and the flu pandemic of 1918-1919 may have started in this way, although an avian origin is probably more likely. Evidence for the transmission of influenza from the pig to other mammals was first obtained by Richard Shope in 1932. He managed to infect various animals with swabs taken from nasal secretion of pigs suffering from swine flu. His proposition, that the pig could be a kind of safe haven (reservoir) for the virus between human epidemics and pandemics, is widely accepted. 

The influenza strain of 1918 appears to have had a haemagglutinin protein that was especially well adapted for human-to-human transmission and with a neuraminidase that allowed a specially efficient release of new virus particles. Certainly, the mortality was high and there was a unique age distribution. Usually, influenza produces a U-shaped mortality curve with excess death amongst the very young and the very old. The 1918 pandemic produced a W-shaped curve with a very significant additional peak in the 15- 45 age range. 

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Echinacea, a frequently used herb, is taken to stimulate the immune astern function by increasing the number and activity of immune cells and to stimulate phagocytosis (ingestion and destruction of bacteria and other harmful substanceIt appears to shorten the duration of colds and influenza. 

Ephedrine and pseudoephediine are a vasodilator and decongestant respectively used widely in the treatment of asthma and the symptoms of colds and influenza. These pharmaceuticals were derived originally fi om the plant Ephedra sinica and used in traditional Chinese medicinal preparations. Although some are still produced fi om such sources, the major production is via a fermentation process followed by a chemical catalytic reaction. As shown in Figure 1, the intermediate / -phenylacetylcarbinol (PAC) is produced by decarboxylation of pyruvate followed by ligation to benzaldehyde. 

The purple coneflower Echinacea purpura, and its close relatives, E. angustifolia and E. pallida, are the source of the herb Echinacea, which is widely popular as a nonspecific immune stimulant. These perennials are native to the prairies of North America and are now widely grown garden ornamentals. The root and aerial parts of the plant are the portions used, and the preparation s potency can be verified by the transient tingling sensation produced when it is tasted. Echinacea contains alkamides, caffeic acid esters (echinacoside, cichoric acid, caftaric acid), polysaccharides (heteroxylan), and an essential oil. Some echinacea products are standardized for their echinacoside content. In the past, adulteration with American feverfew (Parthenium integri-folium) was common. Echinacea is now sold either by itself or in combination with golden seal or zinc for the treatment of colds and influenza. 

These properties of the flowers are obtained from infusions of 1 ounce to 1 pint of water in wineglass doses. It is used, often in conjunction with Peppermint and Yarrow, chiefly for the reduction of feverish colds, but inflamed conditions of the eyes are also found to yield to bathing with the warm Elder flower infusion. Although the medicinal qualities are weaker in the berries than in the flowers, the popular Elder berry wine is widely used as part of the treatment for colds and influenza. 

Aucamp and Meyer (131) reported that well- Controlled epileptics may experience sudden exacerbation of their seizures If they begin taking drugs with anticholinergic activity (as In some antacid preparations) or antlhlstamlnlc activity (as In preparations for amelioration of colds and Influenza). 

Two common upper respiratory tract conditions - the common cold and influenza - exhibit similar symptoms and are often confused by patients. Their features are compared in Table 21.1. 

Table 20.1 Clinical features of the common cold and influenza...

Like the common cold and influenza, it is a social disease, since the bacillus is transmitted by droplets carried through the air and in infected sputum. Carriers of the bacillus are generally unaware of its presence and show no symptoms of overt tuberculosis. They may, however, be identified by the tuberculin test, invented by Robert Koch in 1890. This involves impregnation of the skin with a small amount of heat-inactivated bacillus and observing the formation of a classic immune response. 

The rest of this chapter will show how the most successful treatment modalities have developed. These include vaccination (for smallpox, polio, measles, etc.), and chemotherapy using anti-viral drugs. A large number of viral diseases still lack an effective means of treatment, and the chapter will also cover the attempts to treat the common cold and influenza the struggles with HIV and the emergence of viruses (Marburg, Ebola, Lassa) that cause haemorrhagic fever. 

It is broadly employed for the treatment of herpes zoster, herpetic-keratitis, herpes genitalis, chronic hepatitis, common cold and influenza. It also finds its usefulness in limg carcinoma, breast cancer, multiple myelomas. It is also recommended as a prophylactic agent in cytomegalovirus infection in renal transplant patients. 

The interaction between the MAOIs and oral phenylephrine is established, serious and potentially life-threatening. Phenylephrine commonly occurs in oral non-prescription cough, cold and influenza preparations, so patients should be strongly warned about them. Whether the effects of nasal drops and sprays and eye drops are also enhanced is uncertain, but it would be prudent to avoid them until they have been shown to be safe. The response to parenteral administration is also approximately doubled, so that a dosage reduction is necessary. 

Leyer, G. J., Li, S., Mubasher, M. E., Reifer, C., Ouwehand, A. C. (2009). Probiotic effects on cold and influenza-hke symptom incidence and duration in children. Pediatrics, 124(2), el72-el79. 

Lead workers PbB range 22-89 gg/dl Respiratory ailments, associated effects on immune responses More colds and influenza infections per year than controls secretory IgA suppressed Ewers et al. (1982)... 

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