Rabies; clinical features, treatment and prevention

Introduction

This is an acute notifiable and deadly communicable disease transmitted by a bite from an infected animal caused by rhabdovirus which is found in the saliva of infected animals (usually dogs, cats, foxes. wolves and bats).

Mode of transmission: this is by the bite of an infected mammal, most commonly stray (and also cats, wolves, and bats).

Photo by Boehringer Ingelheim

Incubation period: 9 - 90days.

Diagnosis: history of dog or bat bite plus neurological features

Clinical feature

  • Prodromal symptoms;
    • Itching and pain at the site of bite.
    • Fever.
    • Chills.
    • Malaise.
    • Headache.
  • Hydrophobia.
  • Involuntary movement and muscle spasms.
  • Hallucinations.
  • Very aggressive.
  • Paraplegia and loss of sphincter control.
  • Intense excitement.

Treatment

  1. Observe the biting animal if possible to see if the animal dies.
  2. Clean the wound.
  3. Give tissue-culture rabies vaccine on 0, 3, 7, 14, 30 and 90 days.
  4. Give anti-tetanus toxoid.
  5. Give rabies immune globulin (RIG) if possible (give around the wound). Discontinue treatment if the dog/mammal remains healthy for 10days.
  6. The patient should be sedated with diazepam if there is agitation and supplemented by chlorpromazine 50-lOOmg if necessary.

Prevention

  • Pre-exposure prophylaxis with human diploid cell strain vaccine.
  • Post-exposure prophylaxis with human rabies immunoglobulin.

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