RABIES

ALPHA
Definition

• It is a viral disease of the CNS caused by the Rabies

virus usually transmitted to man through a bite by
an infected animal e.g. dog, fox, cat, etc.

• NOTE: Following a bite if the offending animal

remain healthy for 7-10 after the incident, it is
practically certain that no rabies virus was present
in the saliva.( Wilcocks& manson-Bahr)
Geographical distribution

• It occurs in most parts of the world but some countries like Britain,
Australia and Japan are free from indigenous infection although case
in immigrants to those places are reported

• INCUBATION PERIOD
In man the incubation period varies from 2weeks-2years but usually
1-3 months
Pathophophysiology

• Following entry into the body e.g. after a bite the

virus start multiplying at the bite site and later
moves from the bite site to the CNS and reaches the
brain where it continues multiplying and can spread
outward along the peripheral nerves causing
interstitial neuritis. It mar also reach the muscles
and salivary gland (this shows that it is not strictly
neurotropic)
• The virus cause an immune reaction where ever it
goes giving rise to the typical signs and symptoms
of Rabies
Signs and symptoms

• The signs and symptoms are classified into 2 i.e., Furious

type and the Paralytic or dumb type.
• Furious type: is characterized by change of character and
habits to being more aggressive.
• There is
• a rise in temperature,
• patient appears anxious.
• Irritable,
• insomnia
• Reflexes are increase
• Pupils are dilated
Furious clinical features cont

• Headache
• Body pains
• Painful muscles
• Sore throat
• Nausea and vomiting
• Painful spasms of the pharynx and larynx worsened
by drinking water
• Episthotonus due to muscle spasms
• Voice become hoarse
• Mucus collects in the mouth
Furious clinical features cont

 Spasms of other muscle are present

 There is an exaggerated fear of water that even the
mention can trigger spasms (Hydrophobia)
 Delirium
 Hallucination
 Convulsion will also set in
 Parasthesiae of the trunk, limbs and face sets in.
 Sexual excitement with priapism is common
 Squinting may develop
 Face may lack expression
 There may be inability to close mouth and eyes
Furious clinical features cont

• Repeated spasms of the respiratory muscles lead to difficulties in

breathing and cyanosis
• The convulsions become more and more until the patient dies.
• Death is usually 5-10 after onset of symptoms
Clinical features of the paralytic form
• Here symptoms tend to be less marked and diagnosis may
be missed
The patient is depressed and apathetic
Fever is present
Malaise
Weakness
Ataxia
Paralysis due acute progressive ascending myelitis. Paralysis
begins in the legs
Encephalitis develops and patient may go into coma.
Death may not take place for a month but is innevitable.
Diagnosis

• History may reveal a bite by a dog ,cat, fox, etc

• Cardinal clinical features e.g. hydrophobia with
spasms.
• Viruses can be isolated from the patient’s saliva or
specimen tissue.
• Fluorescent antibody test can be positive
• Animal suspected of causing rabies should be
isolated and kept under observation for 10days. If it
does not die within 10 days then it is not rabid
Treatment

• Treatment should not await the results of

laboratory tests.
Human rabies immunoglobulin should be given
immediately 20 IU/kg body weight half of this
should be given around the wound area and the
other half i.m.
5 doses of Human diploid cell vaccine (HDCV)
1.0mls first dose day 0 followed by injection on
days, 3,7 ,14 and 28
Cleansing of the wound should be done 20% soap
solution
Treatment cont

Topical application of anti-rabies serum or powdered globulin

ATT may be give 0.5mls
Antibiotics may be give to treat or prevent bacterial infection e.g.
Procaine penicillin 600mg od for 5/7
Oxygen therapy may also be given.
Prevention

• Vaccination of all domestic dog

• Reporting of any cases to the authorities so that preventive measure
are taken to prevent further cases
• Immunization of those at high risk e.g. veterinary workers. 2 doses of
H.D.C.V. 1ml deep im given 4 weeks apart.
Booster dose may be given one year later.