23 - Rabies

Question 1

Rabies infection

Answer 1

Acute inectious fatal viral disease of most warm-blooded animals
Common in
- wolves
- bats
- cats
- dogs

Question 2

Rabies affects?

Answer 2

Attacks the CNS

Question 3

Types of rabies?

Answer 3

Bat rabies (avian rabies)

Terrestrial rabies

Question 4

3rd most reported type of rabies recent years?

Answer 4

Bat rabies - avian rabeis

Question 5

Avian rabies is commonly foun din?

Answer 5

Raccoons
Skunks
Bats

Question 6

Terrestial rabies in US is found in? (Animals)

Answer 6

cats

• east coast: raccoons

Question 7

World wide MC vector of rabies?

Answer 7

Dog
NHP is #2
(Non human primate)

Question 8

What animal doesnt spread rabies well?

Answer 8

Rodents
- they die before spreading

Except groundhog

Question 9

Human to human rabies transmission?

Answer 9

Corneal transplants

Organ transplants

Question 10

Bats and rabies?

Answer 10

Any exposure to bats while in a state of altered consciousness (including sleep) constitutes an exposure to rabies

You gettin the shot

Question 11

Rabies genus?

Answer 11

Lyssavirus

Question 12

Rabies transmission?

Answer 12

Enters muscles and replicates locally

Enters spinal ganglia - replicates again
- moves up the coard

Migrates to gray matter
- limbic system - midbrain - hypothalamus

Question 13

How does rabies spread from victim to victim?

Answer 13

The efferent nerves transport virus -> salivary glands in high concentrations

Question 14

Rabies incubation?

Answer 14

5 days to 7 yrs

Average 1-3 months

Question 15

Factors that increase disease manifestations?

Answer 15

Quantity of virus in saliva
- drool vs bite
Species of animal

Site of bite (head/neck = bad)

Antirabies treatment

Question 16

Phases of rabies?

Answer 16

1. Incubation - post bite
2. Prodromal period - 2-10 days
3. Acute neurologic period - 2-7 days
   - furious rabies
   - paralytic rabies
4. Dead period - UTC

Question 17

Incubation period s/s?

Answer 17

Asymptomatic

No antibody response

Question 18

Prodromal period s/s?

Answer 18

Virus enters CNS

Nonspecific s/s

• malaise
• ha
• chills
• anorexia
• fever
• pharyngitis

Paresthesia or pain

Question 19

Pathognomonic for prodromal rabies?

Answer 19

Paresthesia or pain - maybe prickly itchy feeling at inoculation site

Question 20

Acute nuerologic - furious rabies s/s?

Answer 20

Agitation
Restlessness
Biting
Hallucinations
Episodic - 5 min episodes
Hyperacity
Thrashing
Confusion 
- fever + HA

Question 21

Furious rabies can be triggered by?

Answer 21

Visual, auditory or tactile stimuli

Question 22

Paralytic rabies s/s?

Answer 22

Aka - dumb or apathetic rabies
(20% of cases)
- pt is quiet
- paralysis from outset
- fever + HA

Question 23

Neurologic period physical findings?

Answer 23

Delirium
Restlessness
Seizures
Aniscoria
Lacrimation
Perspiration
Drooling
Hydrophobia
Aerophobia
Psychosis
Thrashing
Aphasia
Mydraisis 
Salivation
Postural HOTN
Muscular fasciculations

Question 24

Pathognomonic for rabies neurologic period?

Answer 24

Hydrophobia

Aerophobia

Question 25

Rabies eventually leads to?

Answer 25

Coma (w/in 10 days of onset)

Recovery unlikely

Question 26

Rabies diagnosis

Answer 26

Typically clinical

RFFIT: Serum rapid fluorescent focus inhibition test
Nuchal skin biopsy
Saliva test - takes 2 weeks

Question 27

MR reliable rabies test in the 1st week?

Answer 27

Eosinophilic cytoplasmic inclusinos - negri bodies
- 70% of cases

PATHOGNOMONIC

Question 28

Rabies ddx?

Answer 28

Tetanus
Guilliain-barre 
Viral encephalitis
Transverse myelitis
CVA
Intracranial mass
Epilepsy
Atropine poisoning
Creutzfeld-jacob disease
Psychosis

Question 29

Rabies tx?

Answer 29

Passive and active immunization

Immediate vigorous wound clensing

Question 30

Rabies vaccines?

Answer 30

HDCV - Human diploid cell vaccine

PCEC - purified chick embryo vaccine

Question 31

Preexposure vaccine?

Answer 31

Primary immunization
- days 0, 7, 21 or 28

Booster

Question 32

Post exposure rabies vaccine?

Answer 32

No prior vaccine
HDCV/PCEC - days 0, 3, 7, 14

Prior vaccine - days 0 and 3

Question 33

Rabies passive immmunization?

Answer 33

HRIG - immune globuine

• infiltrated around the wound
• remaining into glute (opposite side of active vaccine)

DONt exceed 20 IU/kg

Question 34

Extremely critical to rabies tx?

Answer 34

Wound clensing

Vaccine booster q 2 yrs (CDC) or q 1 yr (WHO)

Corticosteroids decrease antibody response

Question 35

Wound closure for suspected rabies?

Answer 35

Secondary - DO NOT close the wound

Question 36

I’m not sure what my spirit animal is

Answer 36

But i’m confident it has rabies