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Infectious Disease > 203 Rabies > Flashcards

203 Rabies Flashcards

1
Q

True or false. Rabies has encephalitic and paralytic forms that progress to death

A

True.

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2
Q

Two genera of rabies that cause human disease

A

Lyssavirus and Vesciulovirus

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3
Q

True or false. Rabies is usually transmitted to humans by the bit of an infected animal

A

True.

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4
Q

True or false. Rabies may be acquired from skunks, foxes and raccoons.

A

True.

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5
Q

True or false. In North America, human disease is usually associated with transmission from bats

A

True

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6
Q

True or false. Transmission from nonbite like exposures is relatively uncommon.

A

True

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7
Q

incubation period of rabies

A

20-90 days, rare less than 1 day and more than 1 year

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8
Q

True or false. During the incubation period, the rabies virus is thought to be present at or close to the site of inoculation

A

True.

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9
Q

the rabies virus is known to bind where in the nerves

A

bind to nicotinic acetylcholine receptors on postsynpatic membranes at neuromuscular junctions

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10
Q

how does rabies virus spread inside the body

A

centripetally along the peripheral nerves towards the spinal cord or brainsteam via retrograde fast axonal transport

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11
Q

what is the axonal transport speed of rabies virus

A

250 mm per day with delays of 12 hrs at each synapse

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12
Q

prominently affected in rabies

A

neurons

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13
Q

where does rabies virus replicate

A

in acinar cells of the salivary glands and is secreted in the saliva of rabid animals that serve as vectors

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14
Q

True or false. There is no well documented evidence for hematogenous spread of rabies virus

A

True.

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15
Q

microglial nodules seen in rabies

A

Babes nodules

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16
Q

most characteristic pathologic finding in rabies

A

Negri bodies

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17
Q

Negri bodies vs babes nodules

A

negri bodies are cytocplasmic inclusions in brain neurons composed of rabies virus proteins and viral RNA while Babes nodules are mononuclear inflammation of microglial nodules

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18
Q

Where are Negri bodies in rabies observed

A

Prukinje cells of the cerebellum and in pyramidal neurons of the hippocampus and cortical and brainstem neurons

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19
Q

responsible for clinical disease in rabies

A

neuronal dysfunction

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20
Q

True or false. Negri bodies are no observed in all cases of rabies

A

True.

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21
Q

relates tot he aggressive behavrious of rabid animals

A

infection of serotonergic neurons of the brainstem

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22
Q

How does rabies present

A

atypical encephalitis with relative preservation of consciousness

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23
Q

phases in rabies infection

A

prodrome, acute neurologic, comatose and death

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24
Q

motor weakness in rabies

A

acute flaccid paralysis

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25
Q

the clinical feature of this phase is nonspecific manifestation like fever, malaise, headache, nausea, and vomiting

A

Prodrome

26
Q

earliest specific neurologic symptoms of rabies which occur in 50-80% of patients

A

paresthesia, pain or pruritus near the site of exposure

27
Q

two acute neurologic forms in humans

A

encephalitic (furious) form 80% and paralytic form 20%

28
Q

signs of rabies encephalitis involving the brain stem

A

hydrophobia and aerophobia

29
Q

what is hydrphobia

A

involuntary painful contraction of the diaphragm and accessory respiratory, laryngeal and pharyngeal muscles in response to swallowing liquids

30
Q

mechanism of hydrophobia or aerophobia

A

exaggerated defense reflexes by the nucleus ambiguus that inhibit inspiratory neurons to protect the respiratory tract

31
Q

autonomic dysfunction in rabies

A

hypersalivation, gooseflesh, cardiac arrythmia, and priapism

32
Q

True or false. Paralytic rabies is seen in 20% of patient in which weakness predominates and cardinal features of hyperexcitability, hydrophobia and aerophobia are lacking

A

True.

33
Q

Cause of coma or death in patient with rabies

A

brainstem dysfunction

34
Q

from where are skin biopsy for rabies taken

A

cutaneous nerves at the base of hair follicles, samples are usually taken from hairy skin at the nape of the neck

35
Q

True or false. Corneal impression smears are of low diagnostic yield and are not generally performed

A

True.

36
Q

True or false. Presence of rabies virus specific neurtralizing antibodies in the CSF suggest rabies encephalitis, regardless of immunization

A

True.

37
Q

diagnostically useful specimen in the diagnosis of rabies

A

serum, CSF, saliva, skin biopsy and brain tissue

38
Q

a highly and specific test for detection of rabies virus RNA

A

RT PCR

39
Q

True or false. There is no established treatment for rabies

A

True.

40
Q

what is the prognosis of rabies

A

almost uniformly fatal

41
Q

how long should healthy dogs, cats or ferrets be confined and observed

A

10 days

42
Q

True or false. PEP for rabies is not necessary if the animal remains healthy

A

True.

43
Q

True or false. If the the animal develops signs of rabies during the observation, it should be euthanized immediately

A

True.

44
Q

Part of the animal sent for testing and viral isolation

A

head

45
Q

True or false. In high risk exposure and in areas where canine rabies is endemic, rabies prophylaxis should be initiated without waiting for laboratory results

A

True.

46
Q

Not later than how many days can RIG be administered after the first dose if not immediately available

A

no later than 7 days

47
Q

can you give RIG 7 days after the first dose

A

theoretically endogenous antibodies are being produced and passive immunization is counterproductive

48
Q

what is the dose of RIG

A

20 U/Kg, entire dose to site if anatomically feasible, if not then administered IM at a distant site

49
Q

when can RIG administered all IM

A

if exposure involves mucous membrane

50
Q

true or false. Pregnancy is a contraindication to rabies vaccine

A

False. Not contraindicated for immunization

51
Q

Can glucocorticoids be given along with rabies vaccine?

A

No. it may interfere with the development of active immunity

52
Q

when should purified inactivated rabies be given

A

immediately

53
Q

timing of the purified inactivated rabies vaccine

A

Day 0, 3, 7, 14

54
Q

alternative to RIG if not available and the dose

A

purified equine RIG can be used at dose of 40 U/ Kg

55
Q

How to give pre exposure rabies vaccination

A

Day 0,7, 21 or 28

56
Q

differentiate pre exposure versus post exposure vaccination

A

Post exposure: given 4x; Day 0,3,7,14 Pre exposure given 3x: Day 0, 7, 21

57
Q

who are given pre exposure vaccination

A

travelers to endemic areas, occupational or recreational risk

58
Q

who can be given booster rabies vaccination and how administered

A

previously immunized individual with booster dose given day 0 and day 3

59
Q

True or false. RIG should be given to previously vaccinated persons

A

False. No need. Endogenous antibodies might already have developed

60
Q

True or false. vesiculovirus can infect humans. It can cause flu like illness, conjunctivitis and small vesicular lesions

A

True.

61
Q

True or false.Vesicular stomatitis virus lasts 3-6 days with complete recovery and rarely leads to encephalitis

A

True.

Infectious Disease (8 decks)

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