RABIES

Symptpms
History of animal bite may be not
remembered
Pain at the site of the bite in association
with fever, malaise, nausea, and vomiting
The skin is sensitive to change of
temperature, especially air currents
About 10 days later, the CNS stage
begins: encephalitic (furious) or paralytic
(dumb) Signs

Signs
The encephalitic form the classic rabies
manifestations:
delirium alternating with periods of calm
When attempts at dringking cause extremely
painful laryngeal spasms (hydrophobia)

In the less common paralytic form

An acute ascending paralysis resembling GuillanBarre syndrome

Both forms (encephalitic & paralytic) progress to

Coma
Autonomic nervous system dysfunction
Death

Management

Prevention
Local treatment of animal bite
Postexposure immunization
Preexposure immunization
Treatment

Prevention
Immunization of household dogs & cats
Active immunization of persons with
significant animal exposure (veterinarians)

Local treatment of animal bites

Thoroungh cleansing, debridement, and
repeated flushing of wounds with soap
and water
Rabies immune globulin or antiserum
should be given
Wounds caused by animal bites should
not be satured

Postexposure immunization
Any contact or suspect contact with a bat is
indication to warrant prophylaxis
Both passive antibody & vaccination
Passive immunization is rabies immune globulin,
20 IUs/kg, the full dose should be infiltrated
around the wound, with any remaining injected
intramuscularly at a distant from the wound
An inactivated human diploid cell rabies vaccine
(HDCV) is given as injections of 1 ml
intramuscularly (in the deltoid) on days 0, 3, 7,
14, 28 after exposure

Preexposure immunization
Preexposure prophylaxis with three
injections of HDCV IM, (1 ml on days 0,
7, and 21/28) or interdermally (0.1 ml on
days 0, 7, 28, over the deltoid) for persons
at high risk of exposure

Treatment
This very severe illness almost fatal
requires intensive care with attention to
the air-way, maintenance of oxygenation,
and control of seizures
Universal precaution are essential
Combination therapy: rabies vaccine,
rabies immune globulin, monoclonal
antibodies, ribvirin, interferron alfa, and
ketamine

Prognosis
Once the symptoms have appeared,
death occurred after 7 days from
respiratory failure

Prognosis
In untreated scrub typhus, the mortality
rate: 0-30%
Prompt antiotic therapy reduces mortality
to zero