Bacterial complications of influenza (literature review)

Influenza epidemics cause morbidity and mortality, both through the direct action of the virus during the first days of disease and through the development of secondary bacterial complications that usually occur after the first week. Studies show that up to 65% of laboratory-confirmed cases of influenza infection are accompanied by secondary bacterial infection, which may have severe consequences, especially for patients in risk groups. This study aimed to systematize the available scientific evidence on the pathogenesis of bacterial complications of influenza. The review showed that secondary bacterial infection occurs typically in patients with influenza A, and those infected with the neuraminidase N2 subtypes usually experience a more severe course of the disease. S. pneumoniae, H.influenzae and S. aureus have been the most frequent pathogens complicating the influenza since the late 1800s. Influenza virus infection has been shown to cause various changes to the respiratory tract epithelium and to alter the immune response, predisposing patients to bacterial complications. The influenza virus is able to damage respiratory epithelial cells and inhibit mucociliary clearance mechanisms. Following bacterial colonization, the development of the disease is due to the specific characteristics of the viral infection, which facilitates bacterial adhesion and penetration. In addition, cytokine profiles have been shown to change in alveolar macrophages, neutrophils, dendritic cells and NK cells, resulting in impaired function of these cells. This leads to an increased inflammatory response and decreased bacterial eradication. However, despite a growing body of work detailing different aspects of the pathogenesis of bacterial complications of influenza, determining the exact contribution of each of the factors described is a complex task to which further research may be helpful. 

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