Rabies

a) Passive immunization
-a rhabdovirus found in the saliva of animals
and is transmitted through bites or scratches.
-Acute encephalitis develops and patients
almost invariably die.
a) Prodromal phase
 nonspecific complaints (fever and
headache)
 paresthesias
 itching or burning at the bite site
spreading to the entire bitten
extremity
b) Acute neurologic phase
-Both forms progress to paralysis,
coma, circulatory collapse, and death.
1. Encephalitic form (furious)
o more common
o fever and hyperactivity that can be
stimulated by internal or external
factors such as thirst, fear, light, or
noise
o fluctuating levels of consciousness,
aerophobia or hydrophobia,
inspiratory spasm, and
abnormalities of the autonomic
nervous system.
-consists of administering 20 IU/kg body
weight of rabies immune globulin.
-The rest can be given intramuscularly at
a site remote from where the vaccine was
administered.
-Patients with preexposure immunization
do not require passive immunization and
need active immunization only on days 0
and 3
b) Active Immunization
1. healthy, immunocompromised:
 consists of administering 1 mL of
human diploid cell vaccine, purified
chick embryo cell vaccine, or rabies
vaccine absorbed intramuscularly:
o into the deltoid in adults
o into the anterolateral
aspect of the thigh in
children on days 0, 3, 7,
and 14.
2. immunocompromised
 five-dose schedule is recommended
on days 0, 3, 7, 14, and 28.

2. Paralytic form
 Fever
 progressive weakness
 loss of deep tendon reflexes
 urinary incontinence.

Management
1. Adequate wound care
 Wounds are washed with soap and
water
 Irrigated with a virucidal agent
such as povidone-iodine solution
 If rabies exposure is strongly
suspected, consider leaving the
wound open.
 A bite from a healthy-appearing
domestic animal does not require
prophylaxis if the animal can be
observed for 10 days.

2. Rabies prophylaxis