Diagnosing and Managing Influenza and Respiratory Syncytial Virus (RSV) Infections in Adults - FLCCC
In adult patients, COVID-19 (Omicron variant), influenza, and RSV present with similar symptoms and can, therefore, be difficult to distinguish. This guide aims to help diagnose and treat Influenza and Respiratory Syncytial Virus (RSV).
For advice on how to protect yourself against infection, see I-PREVENT: COVID Protection Protocol. For treatment of COVID-19, see I-CARE: Early COVID Treatment Protocol.
Influenza characteristically begins with the abrupt onset of fever, nonproductive cough, and myalgia. Other symptoms include malaise, sore throat, nausea, nasal congestion, and headache. Gastrointestinal symptoms like vomiting and diarrhea are usually not part of influenza in adults.
Older adults (≥65 years) and immunosuppressed patients are more likely to have subtle signs and symptoms; they may present without fever and with milder systemic symptoms than other patients; however, older adults have a higher frequency of altered mental status.
To test for influenza, conventional reverse transcription polymerase chain reaction (RT-PCR) assays are preferred, if available; these are the most sensitive and specific tests for diagnosis of influenza virus infection. An alternative diagnostic test for influenza is an antigen detection assay. These assays have low to moderate sensitivity but high specificity.
Respiratory Syncytial Virus (RSV)
RSV is highly infectious, and virtually all individuals have been infected with RSV by the age of two. Previous infection with RSV does not appear to protect against reinfection. Healthy adults are infected with RSV repeatedly throughout their lives and typically have symptoms restricted to the upper respiratory tract.
Signs include cough, cold-like symptoms, runny nose, and conjunctivitis. Compared with other respiratory viruses, RSV is more likely to cause sinus and ear involvement with less prominent fever. RSV is an important and often unrecognized cause of lower respiratory tract infection in older adults and immunocompromised adults.
Diagnosis of RSV is based on a PCR test as well as rapid antigen tests. In adults, the antigen tests have a high specificity however they are less sensitive than PCR-based assays.
Treatment for Influenza and RSV
(Not symptom specific; listed in order of importance.)
This protocol should also be used in patients with an undiagnosed flu-like illness, i.e., those who have not been tested or those whose tests are negative. We would suggest this treatment protocol in those with diagnosed Respiratory Syncytial Virus (RSV); however, in low-risk patients with mild RSV we would suggest omitting Nitazoxanide/ivermectin.
- Nasal Spray: 2-3 times daily
A 1% povidone-iodine nasal spray and a nasal spray with Iota-Carrageenan are potent inhibitors of SARS-CoV-2 and influenza virus, and dramatically alter the course of infections with these viruses. Nasal irrigations with saline as well as neutral electrolyzed water may also be of some benefit.
- Mouthwash: 2-3 times daily
Antiseptic-antimicrobial mouthwashes have been shown to inhibit replication of multiple respiratory viruses, including influenza and RSV. We recommend products containing chlorhexidine, povidone-iodine, cetylpyridinium chloride (e.g., Scope™, Act™, Crest™, or the combination of eucalyptus, menthol, and thymol (e.g., Listerine™).
- Elderberry: 4 times daily, according to manufacturer’s dosing guidelines
NOTE: Some authors have suggested that elderberries be used with caution in patients with autoimmune diseases as well as in patients receiving immunosuppressive drugs. While the data is somewhat contradictory, the preponderance of evidence suggests that elderberries have anti-inflammatory properties. This suggests this nutraceutical is likely safe in patients with autoimmune disease when used for two weeks or less. However, such patients need to monitor their symptoms closely.
- Vitamin C: 500-1000 mg, 4 times daily
Vitamin C has important anti-inflammatory, antioxidant, and immune-enhancing properties, including increased synthesis of type I interferons. The effects of Vitamin C on the course of upper respiratory tract infections have long been recognized.
- Nitazoxanide: 500 mg, 2 times daily
Nitazoxanide (NTZ), an oral antiparasitic drug, has activity against many protozoa and helminths and – like ivermectin – has been shown to have antiviral, anti-inflammatory, and immune-modulatory effects and broad spectrum antiviral activity that includes influenza virus, RSV, and SARS-CoV-2. NOTE: While Nitazoxanide is relatively cheap in most countries (approx. $0.31 per tablet), the main distributor in the U.S. (Alinia™) charges exorbitant prices (> $500 for 6 tablets). We therefore suggest ordering from a compounding pharmacy in the U.S. or from a reliable pharmacy abroad.
- Ivermectin: 0.4 mg/kg daily for 5 days
In-vitro (test tube) studies suggest that ivermectin has broad antiviral activity against RNA viruses including influenza. However, there is no (published) clinical data on the use of ivermectin in the treatment of influenza. Therefore, we recommend ivermectin as part of a multi-drug regimen when nitazoxanide is not available. Ivermectin is best taken with a meal. This drug should be avoided in pregnancy and in patients taking calcineurin inhibitors (cyclosporine and Prograf).
- Zinc: 50-90 mg daily
Zinc is essential for innate and adaptive immunity, with zinc deficiency being a major risk factor for influenza. Prolonged high-dose zinc (> 50mg day) should be avoided, as this is associated with copper deficiency. Commercial zinc supplements are commonly formulated as zinc oxide or salts with acetate, gluconate, and sulfate.
- N-acetylcysteine (NAC): 600-1200 mg orally, 2 times daily
NAC, the precursor of reduced glutathione, penetrates cells where it is deacetylated to yield L-cysteine, thereby promoting glutathione (GSH) synthesis. NAC has a broad range of antioxidant, anti-inflammatory, and immune- modulating mechanisms.
- Sunlight and photobiomodulation (PBM): 30 minutes daily
PBM is also known as low-level light therapy, red light therapy, and near-infrared light therapy. Sunlight has great therapeutic powers. Apart from stimulating Vitamin D synthesis, red and near-infrared light have a profound effect on human physiology, notably acting as a mitochondrial stimulant and increasing ATP production. When it is neither feasible nor practical to expose yourself to midday sunshine, patients can expose themselves to red and near-infrared radiation from LED panels or incandescent lamps.
- Melatonin: 5-10 mg nightly
Melatonin is a potent antioxidant with important anti-inflammatory effects. Slow- or extended-release preparations are preferred. If 10 mg is not well tolerated, cut the dose to 5 mg, and slowly increase as tolerated.
- Symptomatic treatments
In patients who are highly symptomatic, over the counter “flu” preparations with acetaminophen, antihistamines, and a decongestant are suggested.
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