Rabies

By: AIDS
Pharmacy 3B

Case summary
11 year old boy was brought to a hospital in Quezon City after falling.
Symptoms were treated, and he was released.
-The following day

Refuse to drink water with his medicine

Became anxious
Began to act up and hallucinate
Salivating
Difficulty of breathing

-Two days later Fever (40.8C)

Two episodes of cardia arrest

TESTS
No remarkable data obtained from a Computed Tomographic image of the brain or Cerebral spinal fluid analysis
Skin biopsy from the nape o the neck: Viral antigen- (-) day 3; (+) day 7

o His condition continued to deteriorate and died 11 days later

o When the parents were questioned, the child had been bitten on the finger by a dog 6 months
earlier while on a trip to Sagada

Hindi kasama sa finals slide pag

sinabi lang ni sir na related the case
ganern
Ante mortem before death

Sample should be collected before rule out of rabies

Saliva
Using a sterile eyedropper pipette, collect saliva and place in a small sterile container which can be sealed securely. No preservatives or additional material
should be added. Laboratory tests to be performed include detection of rabies RNA (by reverse transcription and polymerase chain reaction, RT/PCR, of
extracted nucleic acids) and isolation of infectious virus in cell culture. Tracheal aspirates and sputum are not suitable for rabies tests.
Neck Biopsy
A section of skin 5 to 6 mm in diameter should be taken from the posterior region of the neck at the hairline. The biopsy specimen should contain a minimum
of 10 hair follicles and be of sufficient depth to include the cutaneous nerves at the base of the follicle. Place the specimen on a piece of sterile gauze
moistened with sterile water and place in a sealed container. Do not add preservatives or additional fluids. Laboratory tests to be performed include RT/PCR
and immunofluorescent staining for viral antigen in frozen sections of the biopsy.
Serum and cerebral spinal fluid (CSF)
At least 0.5 ml each of serum and CSF should be collected; no preservatives should be added. Do not send whole blood. If no vaccine or rabies immune serum
has been given, the presence of antibody to rabies virus in the serum is diagnostic and tests of CSF are unnecessary. Antibody to rabies virus in the CSF,
regardless of the immunization history, suggests a rabies virus infection. Laboratory tests for antibody include indirect immunofluorescence and virus
neutralization.
Brain biopsy
The rarity of rabies and the lack of an effective treatment make the collection of a brain biopsy for antemortem testing unwarranted; however, biopsy samples
negative for herpes encephalitis should be tested for evidence of rabies infection. The biopsy is placed in a sterile sealed container; do not add preservatives
or additional fluids. Laboratory tests to be performed include RT/PCR and immunofluorescent staining for viral antigen in touch impressions.
Postmortem Samples
In certain cases, human samples may need to be tested for rabies postmortem. Consult with the state health department before shipping any samples to the
Rabies Laboratory at the CDC. Fresh tissue samples from the central nervous system (brain) should be submitted.
CARDIAC ARREST VS HEART ATTACK
-abnormal heart beating/ no warning patient lose consciousness
-blockage of artery that supplies blood to the heart/sx: Chest pain, SOB

Introduction

Rabies: Latin verb to rage

Source of great human suffering and fear since ancient times
Deadliest infectious disease known to man
A rapidly progressive, acute infectious disease of the central
nervous system (CNS) in humans and animals that is caused by
infection with rabies virus.
2 form of rabies that progresses to death
Encephalitic- (furious) Characterized by agitation, thrashing, biting,
viciousness, choking, gagging, hyperventilation
Paralytic - (dumb) May become withdrawn and seek seclusion,
apparent depression, increased blood pressure, tachycardia, confusion,
hallucinations, and disorientation

Most common animal sources: bats, cats, dogs, foxes, skunks.

Two form of rabies that progresses

to death
Paralytic
Encephalitic
(dumb)

(furious)

80% of patients

Characterized by agitation, thrashing, biting, viciousness,

choking, gagging, hyperventilation, cardiac arrhythmias

Ends with paralysis and death.

20% of patients

Characterized more by paralytic symptoms, which may

include apathy, apparent depression, increased blood
pressure, tachycardia, confusion, hallucinations,
disorientation.

Ends with coma and death by respiratory failure.

Mostoften experienced by patients whohavebeenexposed

to the virus via bats.

Generally survive a few days longer that Encephalitic rabies,

but multiple-organ failure nevertheless ensures

Pag tinanong lang!!! Hindi ko

nilagay sa slide na.Paralytic
Commonly mistaken as GuillainBarr syndrome
rapid-onsetmuscle weaknesscaused by theimmune system
damaging theperipheral nervous system.
initial symptoms: typically changes in sensation or pain along with
muscle weakness, beginning in the feet and hands.
spreads to the arms and upper body with both sides being involved.
The symptoms develop over hours to a few weeks. [2]During the
acute phase, the disorder can be life-threatening with about 15%
developing weakness of thebreathing musclesrequiring
mechanical ventilation.[1]Some are affected by
changes in the functionof theautonomic nervous system, which can
lead to dangerous abnormalities inheart rateandblood pressure.[2]

Epidemiology
Rabies is a zoonotic infection that occurs in a variety of mammals
throughout the world except in Antarctica and on some islands
Endemic in many resource-poor and resource-limited countries
particularly in Asia and Africa
Eliminated from the United States and most other resource-rich
countries
Can be prevented by vaccination (human) and Animal
immunization

notes
Zoonotic: Pertaining to azoonosis: a disease that can
be transmitted from animals to people or, more
specifically, a disease that normally exists in animals
but that can infect humans
Endemic- regularly found among particular or in a
certain area

Mode of
Transmission
Direct Contact
Animal- Human: Bite by teeth of an infected animal
Non-bite: Scratch of an infected animal,which introduces the virus
through the skin or
mucous membrane

Animal-Animal: Animal with rabies virus attacks other animal

Ingestion of rabid animal

 Indirect Contact
Aerosol transmission from an infected animal, usually a bat. The virus enters
the body through the nasal epithelium
Tissue transplants (such as corneas) Transmission of undetected infections
from donors

notes
Migration to the nervous system is via the nearest sensory or motor neuron in the ganglion at the base of the spinal
cord or to the spinal cord itself. Once there, the virus continues to replicate. (It can then be transported back to the
wound site or up to the brain via the central nervous system.) Axonal transport to the CNS is at a rate of 3 mm per
hour. It is possible however, that the virus also moves across cell-to-cell junctions, and not just among nerve trunks.
In the brain, the virus infects neurons in almost all brain regions, where it continues replication. Neuronal virus
transmission from the periphery of the body to the brain is called "centripetal virus spread." Possible receptors for
the virus are: acetylcholine receptors, gangliosides, and phospholipids.
In aerosol transmission, the virus enters the body through the nasal epithelium and is subsequently transported to
the olfactory bulb. It is thought that the virus replicates in the neurons of the olfactory bulb before spreading to other
neurons in the brain.
After the rabies virus infects the brain, it can continue to spread throughout the body via efferent neural pathways.
At this stage, the virus can be found in salivary glands, taste buds, nasal cavities, tears, skin, the adrenal
glands, pancreas, kidney, heart muscle, brown fat, hair follicles, retina, and cornea. (The virus has never been
detected in blood or blood cells.)

Incubation Period
20 days to 2 months
In some cases, the period can be as short as a few days or as long or longer than 21 years
Incubation period can be determined by several factors
Site of the wound bit
o 60% if the bite is on the face
o 15% to 40% if the bite is on the upper extremities
o

10% if the bite is on the lower extremities.

Proximity to the CNS

o Axonal transport to the CNS is at a rate of 3 mm per hour.

Severity of the bite

o Level 1. (pre-bite) Fearful, aggressive, or obnoxious behavior but no skin-contact by teeth.
o Level 2. (near-bite ) Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and
slight bleeding caused by forward, backward or lateral movement of teeth against skin, but no vertical punctures.
o Level 3.One to four punctures from a single bite with no puncture deeper than half the length of the dogs canine teeth. Maybe lacerations
in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (dog jumps, bites and drops to floor).
o Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dogs canine teeth. May also
have deep bruising around the wound

Quantity of virus injected into the site

Age of the patient
Immune status of the host