RABIES

INTRODUCTION

Rabies is a viral infection that can be transmitted by animals to humans. It is 100% fatal disease that attacks the nervous system with symptoms such as aggressiveness, depression, hydrophobia, aerophobia and paralysis. Until now, there is no effective cure that could save ones life once infected by the rabies.

Definition of Terms
Hydrophobia

fear of the

water encephalitis inflammation in the brain aerophobia - An abnormal and persistent fear of flying

 a mental disturbance characterized by confussion, disordered speech, and halucination. Paralysis - is loss of muscle function for one or more muscles.
delirium

 abnormal drowsiness or stupor, a condition of indifference Malaise Is a feeling of general discomfort or uneasiness, an out of sorts feeling often the first indication of infection.
Lethargy

Animals that transmit rabies

Dog

Cat Goat

Horse Rabbit Monkey

Clinical Manifestations

1. Prodromal/Invasion phase a. The phase is characterized by fever, anorexia, malaise, sore throat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, apprehensiveness, restlessness, sometimes drowsy, mental depression, melancholia, and marked insomia. b. There is pain at the original site of the bite. Headache and nausea may be present. c. The patient becomes sensitive to light, sound and temperature. d. There are pain and aches in different parts of the body. e. Anesthesia, numbness, tingling, burning, and cold sensation maybe felt along the peripheral nerves involved and the site of the bite. f. Mild difficulty in swallowing.

2. Excitement or neurological phase a. This phase is characterized by marked excitation, and apprehension. Terror may even occur. b. There is delirium associated with nuchal rigidity, involuntary twitching or generalized convulsions. c. The patient may exhibit maniacal behavior, eyes are fixed and glossy, and the skin is cold and clammy. d. There is a severe and painful spasm of the muscles of the mouth, pharynx, and larynx, on attempt to swallow water or food or even at the mere sight of them. e. There is aerophobia or intense fear or dislike of flying. f. There is profuse drooling of saliva. g. There is tonic or clonic contraction of the muscles. h. Death may occur during the episode of spasm or from cardiac/respiratory failure. i. If patient survives during this phase, patient deteriorates rapidly and enters to the terminal phase.

3. Terminal/paralytic phase a. The patient becomes quiet and unconscious. b. There is loss of bowel and urinary control. c. Spasm ceases with progressive paralysis. d. There is tachycardia, labored, or irregular respiration. e. Death occurs due to respiratory paralysis, circulatory collapse, or heart failure.

Pathophysiology
Invasion Phase Virus enters the tissue from the saliva of biting animal (incubation 4 days 2 years) Virus replicates in the muscle and connective tissue Virus goes up to peripheral nervous system to CNS in spinal cord virus ascends to the spinal cord Excitement Phase (Neurological Phase) virus reaches the brain encephalitis excitation hallucination convulsion maniacal behavior virus moves thoughout peripheral

- salivary gland drooling of saliva, severe muscle spasm in mouth, pharynx, larynx (hydrophobia)

skin mucosal surface ( cold clammy skin) then increase persperation eyes ( increase lacrimation

Terminal Phase
Paralytic Phase (patient is quite and unconcious) Weakness of muscle muscle spasm local sensation diminished loss of bladder and urinary control ascending pralysis of extremeties until it reaches the expiratory muscle circulatory colapse heart failure coma death

Prevention

The wound must be immediately and thoroughly washed with soap and water. The patient may be given with antibiotics and anti-tetanus immunization Post exposure treatment is given to persons who are exposed to rabies. It consist of local wound treatment is given to persons who are exposed to rabies. Active immunization Passive immunization Then consult a veterinarian of trained personnel to observed your pet for 14 days for signs of rabies. Be a responsible pet owner. Consult for rabies diagnosis and surveillance for the area

Nursing management of rabies exposure

1. Isolate the patient. 2. Give emotional and spiritual support. 3. Provide optimum comfort. 4. Darken the room and provide a quiet environment. 5. Patient should not be bathed and there should not be any running water in the room or within the hearing distance of the patient. 6. If IV fluid has to be given it should be wrapped and needle should be securely anchored in the vein to avoid dislodging in times of restlessness. 7. Concurrent and terminal disinfection should be carried out.