Particularitățile clinice,

evoluția, diagnosticul,
diagnosticul diferențial
al gripei sezoniere,
IACRS, SARI și COVID-
19 la adulți
 IACRS
Rinita acută – obstrucție nazală cu secreții. Etiologie – rinovirusuri,
coronavirusuri, VSR, adenovirusuri, v.influenzae, v.parainfluenzae,
metapneumovirusuri. Incubația 1-3 zile. Alte semne: odinofagie (dureri la
deglutiție), după 1-2 zile pot apărea cefalea și tusea.
Faringita și angina acută – infecții acute ale orofaringelui și amigdalelor
palatine cu febră, sindrom faringian inflamator (eritem, edem, asociate uneori
cu exsudat, disfagie, odinofagie) , CMV, HIV. Etiologie – virusuri 60-80%
cazuri, aceleași ca și în rinita acută (a. eritematoase)+ VEB (a.
pseudomembranoasă) , Herpes Simplex și enterovirusuri (a. veziculare, mai
des vara); bacterii – streptococul beta-hemolitic grup A (a. eritemopultacee),
streptococi gr.B,C,E,G, fuzospirili (a. ulceronecrotice, unilaterale, cu depozit
cenușiu), corinebacterium diphteriae (a. pseudomembranoasă), neisseria
meningitidis, Haemophilus influenzae, etc. Alte semne: adenopatii cervicale.
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• Laringita – răgușeală până la afonie. De obicei, apare în contextul
IACRS virale (adenovirus, v. Gripal, paragripal, VSR, coronavirus).
Bacteriene: corynebacterium diphteriae, streptococ gr. A, moraxela
catarralis. Crupul – obstrucție laringiană, care produce tuse
lătrătoare, stridor inspirator, retracție sternală cu progresie spre
insuficiența respiratorie acută.
• Epiglotita – Hemophilus influenzae gr.B major ca etiologie, dar și
streptococ beta-hemolitic, pneumococ, Staph. Aureus. Debut brusc
spre obstrucție respiratorie, prin edemațierea roșiatică a epglotei, cu
odinofagie, disfagie, salivație intensă. Poziția copilului cu capul
înainte aplicat în față. La examinare cu laringoscopul epiglota apare
ca o cireașă roșie, iar Rx arată o inflamație a laringelui subglotic.

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 SARI (Severe Acute Respiratory Infection)
conform ordinului nr.1103 MSMPS RM din 02.10.2019

• O infecție respiratorie acută cu:

- Istoric de febră sau febră măsurată de minimum 38*C
ȘI
- Tuse
Și
-Debut în perioada de 10 zile anterioare
Și
-Necesită spitalizare

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Pneumoniile reprezinta un
ansamblu de leziuni care
intereseaza parenchimul
pulmonar (alveolita) si
interstitiul pulmonar datorat
unor factori infectiosi
(virusuri, bacterii,
fungi,protozoare).

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 Gripa sezonieră (...dar și despre gripa pandemică)

• A,B,C.

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 Effectiveness of a new bioequivalent formulation of oseltamivir (Enfluvir®) on 2010–2011 seasonal influenza viruses:
An open phase IV studyFebruary 2012. International journal of infectious diseases: IJID: official publication of the
International Society for Infectious Diseases 16(4):e273-8.DOI:10.1016/j.ijid.2011.12.008/SourcePubMed
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9/14/2022 Bohn et al.: Molecular, serological, and biochemical diagnosis and monitoring of COVID-19 15
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9/14/2022 increasing ground glass opacities and an apparent “crazy paving” pattern 18
9/14/2022 doi:10.4414/smw.2020.20304 19
9/14/2022 Three-dimensional volume rendering images (H) 20
 Omicron has many key mutations
compared
to Delta Fig: Delta compared to Omicron with mutations in the S1 domain of the spike
protein

Delta Omicron

• On 26 November 2021, WHO

designated SARS-CoV-2 variant
B.1.1.529 a variant of concern (VOC)
and named it Omicron
• Omicron has > 30 genetic mutations of
the spike protein. The SARS-CoV-2
spike protein acts like a ‘key” and Spike protein
allows the virus to bind to ACE-2 of SARS-
CoV-2
receptor and enter and infect cells in Areas with mutations

humans. More than 70% 40 to 70% 15 to 40% 5 to 15% 1 to 5%

• The spike protein of SARS-CoV-2 is Image: AFP

https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-
targeted by some currently approved concern

COVID-19 vaccines; therefore,

mutations in the spike protein need to 21
be closely monitored
Omicron shows preference for
upper respiratory tract infection
• Omicron appears to show preference for Fig: Upper respiratory tract
infecting and replicating in the upper respiratory
tract, compared to Delta and other strains which
prefer the lower respiratory tract.
• This may confer a transmission advantage
independent of immune evasion
• Preliminary studies suggest that Omicron
appears to have decreased ability to infect lung
tissue, which may be a reason why people
infected with Omicron have a less severe
disease compared to Delta
• Early studies from animal models show that
Omicron-infected animals show fewer
clinical signs and have less severe disease

22
 Omicron has reduced risk of
hospitalization
• Omicron has reduced risk of hospitalization
compared to Delta, suggest early studies from
several countries including Denmark, South
Africa, UK, Canada and the USA
• There is decoupling between case reports and
hospitalization in places of high levels of
population immunity
• Omicron infection appears to be associated with
lower severity and lower proportion of
hospitalized patients compared to previous ©WHO
variants, but the large number of people being
infected with it translates into significant number
of patients requiring hospital admission, putting
strain on healthcare systems.

23
 Routine diagnostics continue to
detect Omicron
• Routinely used diagnostic tests,
including PCR and antigen detection
rapid diagnostic tests (Ag-RDT),
continue to detect infection with
Omicron

• Studies of the comparative

sensitivity of Ag-RDTs are ongoing

©WHO

Source:
Enhancing Readiness for Omicron (B.1.1.529): Technical Brief and Priority Actions for Member States
(who.int)

24
Omicron shows increased re-
infection risk after previous SARS-
CoV-2 infection
• There is evidence that Omicron has some immune evasion*
• Increased trend in re-infection** cases have been reported by some countries including South
Africa, UK, Denmark, Israel
• The risk of reinfection with the Omicron variant was estimated to be 5.4 fold higher in comparison
with the Delta variant in England, show UK studies
• Significant reduction in antibody neutralization*** with Omicron may contribute to increased
risk of re-infection

Public health and safety measures such as:

wearing a mask properly, keeping distance and
washing
hands regularly , continue to protect against infection by
all SARS-CoV-2 variants
*Immune evasion refers to the ability of the virus to evade a person’s protective immune system
**Re-infection refers to infection after previous SARS-CoV-2 infection, while breakthrough infection refers to infection after
vaccination.
***Test to detect levels of antibodies that bind the virus and prevent its infection

Source: Enhancing Readiness for Omicron (B.1.1.529): Technical Brief and Priority Actions for Member States (who.int)

25
Preserved cellular immune process
protects against severe disease
• Protection through cellular immunity*
appears to be preserved in Omicron
infection
• In those who have been previously
infected, and/or previously vaccinated, 70-
80% of certain cells involved in the
protective immune process (CD4+ and
CD8+) were maintained for Omicron
infection
• This likely translates to protection against
severe disease and death after vaccination
and after previous infection, remaining high

Image: Juan Gaertner / Science Photo Library

*Cellular immunity is a protective (non-antibody) immune process involving immune cells which kill virus-infected cells.

Source: Enhancing Readiness for Omicron (B.1.1.529): Technical Brief and Priority Actions for Member States (who.int)

26
Therapeutics and
Omicron
• Interleukin-6 receptor blockers and
corticosteroids are expected to remain effective
in the management of patients with severe
and critical disease
• Preliminary data from non-peer reviewed
publications suggest that some of the
monoclonal antibodies developed against SARS-
CoV-2 may have impaired neutralization against
Omicron

©WHO

27
Older people and those with
underlying conditions remain at
risk
• Older people continue to be at greater risk for
developing severe disease
• Those with underlying conditions, of any age, are also
at risk for developing severe disease

People at greater risk of COVID-19 include those:

unvaccinated, with obesity, people over the age of 60,
hypertension, Diabetes mellitus, cardiac disease,
chronic lung disease, cerebrovascular disease,
dementia, mental disorders, chronic kidney disease,
immunosuppression, cancer, HIV/AIDS,
pregnancy.

©WHO

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