RABIES

…when “man’s best friend” betrays.

Top 10 1987-2007

1 INDIA 244478
2 BANGLADESH 22900
3 CHINA 13995
4 PHILIPPINES 5658
5 VIET NAM 5183
6 PAKISTAN 2843
7 SRI LANKA 2042
8 MYANMAR 1683
9 THAILAND 1377
10 INDONESIA 1208
WHO 2008
 RABIES Defined
• a zoonotic disease
that is caused by
rhabdovirus.
• a disease that
causes
acute encephalitis
in warm-blooded
animals.
 The Culprit: RHABDOVIRUS
• Thought to be the origin of
vampire legends (bats, biting,
hypersexuality)
• Commonly known as rabies
virus
• a virus that attacks the central
nervous system of warm-
blooded animals (only
mammals, including human)
• From Lyssavirus genus
• length =180 nm;
• cross-section = 75 nm
• Enveloped, single stranded,
RNA
 Rabies Reservoirs

• Racoon
• Silvertailed bat

• Red fox • Striped skunk

 Rabies Reservoirs

• Men

• Dogs • Cats
 Mode of Transmission
• Bite of infected
animals through the
skin and mucous
membrane
• Licking of infected
animals to
damaged mucous
membrane
• Aerosol
transmission (bat)
 Incubation Period
• Incubation period varies from 2
weeks to a year
(depends on how large the
infecting dose and how fast).
• The virus travels to the CNS:
– human - 10 days - 1 year (most cases
occurring 20 - 90 days after exposure)
– Bite occurring in the head, neck &
upper extremity IP < 30 days.
• Animal are infectious only weeks
before they die
 Nursing Care: Post-Exposure
Wound Care
• Prompt and thorough
cleaning: flush
wound with soap and
water
• Benzalkonium
chloride not superior
to soap
• Update tetanus
immunization
• Treat secondary
bacterial infection
• Do not suture wound
if possible
 Signs and Symptoms
• Early-stage: flu-like
– Fever
– Headache
• 2nd stage:
– Malaise
– Acute pain
– Violent movements
– Uncontrolled excitement
– Depression
– Hydrophobia
 Signs and Symptoms
• Critical stage
– Paranoia
– Terror
– Hallucinations progressing to delirium
– signs of hyperactivity (furious rabies)
– paralysis (dumb rabies) to complete paralysis
– coma and death in all cases (due to breathing
failure)
 Clinical Manifestations
• Fever
• Nuchal rigidity
• Paresthesia
• Fasiculations
• Convulsions
• Hypersalivation
• Hyperventilation
 Laboratory Diagnosis
• Direct microscopic demonstrate of
virus antigen by: Direct
immunofluorescence staining → detect
virus in brain tissue and corneal
scrapings.
• Brain biopsy→ histologic staining of
brain tissue (seller stain).
 Laboratory Diagnosis
• Animal inoculation → tissue or saliva
inoculated intracerebral into mice
– presence of rabies virus is indicated by
1. flaccid paralysis of leg
2. encephalitis
3. death
• Serological
– detect rabies antibodies by
1. Immunofluorescence test
2. Complement fixation test
3. Neutralization test
• Antibodies are developed during progression
of the disease.
• Rabies control
– Eliminate rabies from Prevention
hosts/victims
• Oral baits w/antivirus.
– Has been effective
(Europe, Canada).
– Slowed potential
outbreak in Ohio
raccoons.
– Used in Texas for
coyotes & foxes.
• Trap/vaccinate/releas
e (TVR)
– Effective in Canada
raccoons.
– Often combined with
oral baits.
• Control measures
against canine;
– stray dog control. Prevention
– vaccination of dogs.
– quarantine of
imported animals.
• Wildlife - Rabies in wild
animals is much more
difficult to control than
canine rabies. However,
on-going trials in in the
USA and Europe using
bait containing rabies
vaccine given to foxes
and raccoons reduces
rabies levels.
• Pre-exposure
prophylaxis: Prevention
vaccination of
people in high
risk groups:
– Veterinarians
– Animal handlers
– Certain lab
workers
– Travel to areas
where canine
rabies is common
 Milwaukee Protocol
• Basic treatment
– Assure airway
– External cardiac pacing wires
– Maintain central venous pressure
– Nasojejunal (NJT) feeding
– Heparin prophylaxis
– Physical therapy
– Prophylactic supplementation of
cofactor deficiencies
 Milwaukee Protocol
• Sedation
– Deep sedation-anesthesia
• Ketamine
• Diazepam or alprazolam
– Continuous EEG monitoring
 Milwaukee Protocol
• Antiviral treatment
– Avoid ARV after onset of clinical
symptoms
– Avoid ARIG and IFNα
– Ribavirin no longer recommended
– Amantadine per NJT
– Monitor rabies titer
• CSF assay q7d
• Saliva & serum assays q2d
 Rabies Survivor:
the ‘Medical Marvel’
Jeanna Giese
-18 years old
-one-of-a-kind
case: She
survived
rabies without
vaccination
Thank You! :D

Ameril, Hayma M.