Lec 19 Animal Bites and Rabies Flashcards
Antibiotic therapy for bitten patients:
Treat bitten patient with a combination of B-lactams and B-lactamase inhibitors
5 proteins encoded by rabies virus
N, NS, M, G, L
Major influencing factors in the incubation period of Rabies.
- Virus load
- Virus strain
- Severity of exposure (multiple bites, size &
depth of bite) - Localization of exposure (the site of inoculation: the nearer to the brain, the shorter incubation period)
Non-specific symptoms of malaise, fatigue, headache, fever, nausea and vomiting, non-productive cough, anorexia, sore throat and paresthesia are experienced during which phase of RABIES?
Prodrome phase
Identify Clinical Manifestation Phase of RABIES:
· Excessive motor activity
· Excitation and agitation
· Confusion, hallucination, combativeness
· Bizarre aberration of thought, muscle spasms
Encephalic Phase
Identify Clinical Manifestation Phase of RABIES:
Hydrophobia
Brainstem Dysfunction Phase
Identify Clinical Manifestation Phase of RABIES:
Cranial nerve involvement
Respiratory center involvement
Brainstem Dysfunction Phase
Median survival period after onset of symptoms of Rabies.
4-20 days
Causes of death in Rabies patients
coma and apnea
The first rabies specific symptom
pain or paresthesia
Late complications of Rabies infection include:
a. SIADH
b. cardiac arrhythmia,
c. ARDS,
d. thrombocytopenia,
e. NOTA
f. AOTA
f. AOTA
Others:
diabetes insipidus, vascular instability, UGIB, Paralytic Ileus
Encephalitic vs Paralytic Rabies:
Fluctuating consciousness
Encephalitic
Encephalitic vs Paralytic Rabies:
Autonomic dysfunction
Encephalitic
Encephalitic vs Paralytic Rabies:
80% of Rabies cases
Encephalitic
Encephalitic vs Paralytic Rabies:
Complete paralysis and Guillain-Barre like symptoms
Paralytic
Cytoplasmic inclusion bodies in the brain tissue of Rabies patients.
Negri bodies
Gold standard for the diagnosis of Rabies
4-fold rise in titer of neutralizing antibodies in serial dilution
Done for viral antigen if brain tissue is available for diagnostic workup.
Direct fluorescent antibody (FA) staining
Done for viral isolation if brain tissue is available for diagnostic workup.
Mouse inoculation
WBC count of rabies patients
a. Very high
b. normal
c. slightly elevated
d. AOTA
d. AOTA
Identify category of exposure to Rabies virus:
- Feeding/touching an animal
- Licking of intact skin
Category 1
Identify category of exposure to Rabies virus:
Minor scratches
Category 2
a. Nibbling/nipping of uncovered skin w/ bruising
b. Minor scratches / abrasions without bleeding*
c. Licks on broken skin
* include wounds that are induced to bleed
T/F: Death can still be avoided once Prodrome Phase of Rabies begins
F. Death is inevitable
The first step of post-exposure treatment for rabies
Local wound care/treatment
Identify category of exposure to Rabies virus:
Minor scratches on head and neck area
Category 3
Identify category of exposure to Rabies virus:
Start vaccine and RIG (preformed antibody) immediately
Category 3
Identify category of exposure to Rabies virus:
Contamination of mucous membrane with saliva (i.e. licks)
Category 3
After administration on wound site, remaining RIG should be injected on the:
anterolateral thigh
Administration of intradermal PVRV/PCECV pre-exposure prophylaxis is done on days 0, ___, ___ and ____
7, 21 and 28 at 0.1ml at site
Continent with the greatest incidence of Rabies
ASIA
