RABIES (hydrophobia, lyssa)

Etiology :
Rhabdo virus

Incubation Period:
3 8 weeks for rabid animals 10 days to 10 years for man

MOT:
saliva of infected animal, bite of dog

Clinical Manifestation:
In animals Dumb stage-withdrawn,stay in one place,overly affectionate,lick wounds.hyperactive Furious Stage-Animal easily bites,vicious look,drooling of saliva

For man,
invasive stage numbness on site of bite
malaise headache restlessness fever photosensitivity apprehension

 excitement stage hydrophobia

spasm of laryngeal and pharyngeal muscle Maniacal climbing the wall and excessive salivation

 paralytic stage laryngospasm stopped

last for how many seconds or hours. Gradual flaccid paralysis that leads to peripheral vascular collapse, coma and death.

Diagnosis:
History of exposure Fluorescent rabies antibody examination of blood Specimen: blood of individual Brain biopsy of animal viral inclusion negri bodies 10 days observation of the animal

 First aid
immediately wash with soap and water at least for 10 minutes to remove saliva dont suture the wound allow blood flow apply sterile dressing

Immunization
Active Intradermal Deltoid Area PRVR-Purified Verocell Rabies Vaccine(VERORAB) Stock-0.5 cc/vial D00.1 ccx 2 sites D3 Left and right Deltoid area D7 D28-30 0.1 cc x 1 site D90 Left or right deltoid area

 PCEC-Purified Chick Embryo Cell Vaccine(RABIPUR) Stock-1 cc/vial D0 D3 0.2 cc x 2 sites D7 Left and right Deltoid area D28-30 0.2 cc x 2 sites D90 Left and right Deltoid area

A.Regular I.M schedule Active Intramuscular Deltoid area D0 D3 1 vial D7 Left or Right Deltoid area D28-30 D90

B.2.1.1 sched. D0 2 vials both left and Right Deltoid muscle D7 1 vial D21 1 vial Left or Right deltoid muscle

Passive Intramuscular Gluteal area ERIG-Equine rabies immunoglobulin Stock-5 cc/vial A. ERIG 0.2 cc of ERIG x Kg/body wt.of the pt.

Note: Skin testing is done before the administration of ERIG B.HRIG-Human Rabies immunoglobulin 0.133 cc of HRIG x kg/body wt of the pt. Note Passive Vaccine should be given before day 7

Management:
Provide a dim and quiet non stimulating room for the patient Wear gown, mask and goggles Always noises should be avoided no matter how minor Restraint the patient when needed Stimulation of any senses by fluid must be avoided

 Prevention:
immunization of animals keep away from stray animals

TETANUS (lock jaw)

CAUSATIVE AGENT
Clostridium Tetani drumstick appearance ANAEROBIC

 MOT
Direct or indirect contamination of obvious or unrecognized wounds Ragged traumatic wounds and burns, Umbilical stump

 SOURCES
Animal or Human feces Soil and dust contains spores

IP
3 days to 1 month or more

PATHOPHYSIOLOGY:
TOXIN TS and TL BLOOD CNS SC and Brain

Signs and Symptoms:

Initial signs of wound inflammation Increase muscle tone near the wound Low grade fever

 Painful involuntary muscle contraction and muscles affected are: Masseter = Lockjaw or Trismus Facial muscle = Risus sardonicus =sardonic smile or grin Muscle of spine = Opisthotonus Respiratory muscle = DOB/dyspnea GUTUrinary retention GITConstipation Abdominal musclerigidity described as board like, if soft=recovery Extremity musclestiffness of extremity=difficulty in flexing it; if observed to have robot gait, it means recovery

2 FORMS (may also be observed)

Local form Cephalic form/ Tetanus

DIAGNOSTIC EXAM
Clinical manifestation History of trauma and no previous immunization

 To neutralize the toxin

Anti-tetanus serum (ATS)/Tetanus antitoxin (TAT) Tetanus immunoglobulin

TREATMENT

To kill the microorganism

Penicillin

For fresh wounds,

daily cleansing with hydrogen peroxide then apply antiseptic (Betadine)

Muscle relaxant such as

Diazepam (Valium) via IV

NURSING FOCUS
irway

ed rest

luster care

iet - SFF im Quiet Room ont leave the patient