Rabies infection
Acute inectious fatal viral disease of most warm-blooded animals Common in - wolves - bats - cats - dogs
Rabies affects?
Attacks the CNS
Types of rabies?
Bat rabies (avian rabies)
Terrestrial rabies
3rd most reported type of rabies recent years?
Bat rabies - avian rabeis
Avian rabies is commonly foun din?
Raccoons
Skunks
Bats
Terrestial rabies in US is found in? (Animals)
cats
- east coast: raccoons
World wide MC vector of rabies?
Dog
NHP is #2
(Non human primate)
What animal doesnt spread rabies well?
Rodents
- they die before spreading
Except groundhog
Human to human rabies transmission?
Corneal transplants
Organ transplants
Bats and rabies?
Any exposure to bats while in a state of altered consciousness (including sleep) constitutes an exposure to rabies
You gettin the shot
Rabies genus?
Lyssavirus
Rabies transmission?
Enters muscles and replicates locally
Enters spinal ganglia - replicates again
- moves up the coard
Migrates to gray matter
- limbic system - midbrain - hypothalamus
How does rabies spread from victim to victim?
The efferent nerves transport virus -> salivary glands in high concentrations
Rabies incubation?
5 days to 7 yrs
Average 1-3 months
Factors that increase disease manifestations?
Quantity of virus in saliva
- drool vs bite
Species of animal
Site of bite (head/neck = bad)
Antirabies treatment
Phases of rabies?
- Incubation - post bite
- Prodromal period - 2-10 days
- Acute neurologic period - 2-7 days
- furious rabies
- paralytic rabies - Dead period - UTC
Incubation period s/s?
Asymptomatic
No antibody response
Prodromal period s/s?
Virus enters CNS
Nonspecific s/s
- malaise
- ha
- chills
- anorexia
- fever
- pharyngitis
Paresthesia or pain
Pathognomonic for prodromal rabies?
Paresthesia or pain - maybe prickly itchy feeling at inoculation site
Acute nuerologic - furious rabies s/s?
Agitation Restlessness Biting Hallucinations Episodic - 5 min episodes Hyperacity Thrashing Confusion - fever + HA
Furious rabies can be triggered by?
Visual, auditory or tactile stimuli
Paralytic rabies s/s?
Aka - dumb or apathetic rabies (20% of cases) - pt is quiet - paralysis from outset - fever + HA
Neurologic period physical findings?
Delirium Restlessness Seizures Aniscoria Lacrimation Perspiration Drooling Hydrophobia Aerophobia Psychosis Thrashing Aphasia Mydraisis Salivation Postural HOTN Muscular fasciculations
Pathognomonic for rabies neurologic period?
Hydrophobia
Aerophobia
Rabies eventually leads to?
Coma (w/in 10 days of onset)
Recovery unlikely
Rabies diagnosis
Typically clinical
RFFIT: Serum rapid fluorescent focus inhibition test
Nuchal skin biopsy
Saliva test - takes 2 weeks
MR reliable rabies test in the 1st week?
Eosinophilic cytoplasmic inclusinos - negri bodies
- 70% of cases
PATHOGNOMONIC
Rabies ddx?
Tetanus Guilliain-barre Viral encephalitis Transverse myelitis CVA Intracranial mass Epilepsy Atropine poisoning Creutzfeld-jacob disease Psychosis
Rabies tx?
Passive and active immunization
Immediate vigorous wound clensing
Rabies vaccines?
HDCV - Human diploid cell vaccine
PCEC - purified chick embryo vaccine
Preexposure vaccine?
Primary immunization
- days 0, 7, 21 or 28
Booster
Post exposure rabies vaccine?
No prior vaccine
HDCV/PCEC - days 0, 3, 7, 14
Prior vaccine - days 0 and 3
Rabies passive immmunization?
HRIG - immune globuine
- infiltrated around the wound
- remaining into glute (opposite side of active vaccine)
DONt exceed 20 IU/kg
Extremely critical to rabies tx?
Wound clensing
Vaccine booster q 2 yrs (CDC) or q 1 yr (WHO)
Corticosteroids decrease antibody response
Wound closure for suspected rabies?
Secondary - DO NOT close the wound
I’m not sure what my spirit animal is
But i’m confident it has rabies