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RABIES

Khrisella Salvador

Rabies

Zoonotic disease

Lyssavirus

Occurring after transdermal bite or scratch by an infected


animal or with direct contact of infectious material on
mucosa or fresh skin lesions

Highly fatal causing fluctuations in consciousness, phobic


or inspiratory spasms and autonomic instability

Rabies

Most acutely fatal infectious disease causing death of 200250 Filipinos per year

<15yo

Male

Dogs

Source of vast majority of human rabies deaths

Modes of Transmission

Bites from infected


animals

Non-bite exposures

Contamination of intact
mucosa

Licks on broken skin

Inhalation of aerosolized
virus in closed areas

Incubation Period
1-3

months

Factors

affecting incubation period

Amount

of virus inoculated

Severity

of exposure

Location

of exposure

Pathogenesis

Inoculation

Multiplication in
myocytes

Replication and
dissemination

Penetrate
peripheral nerve
cells

Clinical Stages

Prodromal

Initial viral replication at striated muscle


cells
0-10 days
Non-specific manifestations
Paresthesia or pain: viral multiplication at
spinal ganglion

Acute Neurologic

Reaches CNS replicating at gray matter

Presentation

Encephalitic or furious

Paralytic or dumb

Autonomic manifestations

2-7 days

Within 10 days of onset

Coma

Respiratory depression,
cardiorespiratory arrest

Death

Clinical Stages

Post Exposure Prophylaxis

Refers to anti-rabies treatment administered after an


exposure to potentially rabid animals

Local wound care, administration of rabid vaccine with or


without RIG

Categories and Management

Categories and Management

Categories and Management

Categories and Management

Local Wound Care

Local Wound Care

Do not apply ointment, cream or wound dressing

Antimicrobials recommended

Frankly infected wound

All category III cat bites

All other category III bites that are either deep, penetrating, multiple, or extensive
or located in the hand, face, and genital area

Anti-tetanus immunization if indicated

Immunization: Active

Intradermal Regimen

Immunization

Intramuscular Regimen

HIV infection, cancer, chronic liver disease, on chloroquine and systemic steroids

Immunization: Passive

Rabies Immunoglobulin

Provide immediate availability of neutralizing antibodies at the site of


exposure before it is possible to begin producing own antibodies

Immunization: Passive
HRIG

preferred

History

of hypersensitivity to equine sera

Multiple

severe exposures especially where the dog is


sick or suspected of being rabid

Symptomatic

HIV patients

Management of Previously Immunized


Animal Bite Cases

Patients with repeat exposure after previous complete primary immunization


and those exposed to rabies after Pre-exposure prophylaxis

Local wound treatment

Management of Previously Immunized


Animal Bite Cases

Management of Bites by Vaccinated


Animals

Vaccinated Animal

At least 1 year and 6 months old and has updated vaccination


certificate from a duly licensed veterinarian for the last 2 years

Updated vaccination

Last vaccination within past 12 months

Management of Bites by Vaccinated


Animals

PEP Deviations: Intradermal

PEP Deviations: Intramuscular

Supportive Management: Anti-Tetanus


Immunization

Supportive Management: Antimicrobials

Pasteurella multocida

Most commonly isolated

Indications

All category III cat bites

All other Cat III bites that are either deep, penetrating, multiple or extensive or
located in hand, face/genital area

Supportive Management: Antimicrobials


Recommended
Antimicrobials

Adults

Children

Amoxicillin/ Clavulanic

500 mg PO TID

30-45 mkday TID

Cloxacillin

500 mg PO QID

10-15 mkday QID

Cefuroxime axetil

500 mg PO BID

10-15 mkday BID

Amoxicillin (prophylaxis)

500 mg PO TID

30-45 mkday TID

Pre-exposure Prophylaxis

Rabies vaccination administered before exposure to potentially rabid animals

Recommended for anyone with continual, frequent or increased risk of


exposure to rabies virus

Pre-Exposure Prophylaxis

END
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