RABIES

Rabies is a viral infection of wild and domestic animals, transmitted to human by saliva of infected animals through bites, scratch or licks on broken skin or mucuos membranes.

Once symptoms develop, rabies presents itself as a fatal encephalitis: there is no cure and treatment is palliative. Before symptomatic disease has developed, rabies can effectively be prevented by post-exposure prophylaxis.

Cause

  • Rabies virus. Incubation is average 20-90 days but can be shorter in severe exposure (multiple bites, bites on face/ neck) of even longer (> a year) in a few cases

Clinical features

  • Itching or paraesthesiae (abnormal sensation) around site of exposure, malaise, fever
  • Neurologic phase
    • Furious form: psychomotor agitation or hydrophobia (throat spasm and panic, triggered by attempt to drink or sight/sound/touch of water) and aerophobia (similar response to a draft of air)
    • Paralytic form (rarer): progressive ascending paralysis

Management

  • There is no cure. In case of suspected exposure, take all the appropriate steps to prevent the infection (see section on animal bites)
  • Start as soon as the exposure happens or as soon as the patient comes for medical attention, regardless of whatever time has passed from the exposure
  • Admit case
  • Palliative and supportive care
  • Observe strict hygienic precautions
    • Avoid contact with patient’s body fluids or secretions
    • PPE (personal protective equipment)
  • Caution: the patient may bite
  • Counsel caregivers on rabies and consequences