Rabies

Question 1

Definition

Answer 1

Acute viral disease of the nervous system of mammals that is caused by rhabdovirus. It is spread by bites from an infected mammal, eg bats, dogs, cats, foxes or racoons and is characterized typically by increased salivation, abnormal behaviour and death if untreated

Question 2

Clinical features

Answer 2

• 9-90 days incubation, so give prophylaxis even several months after exposure
• prodrome: headache, malaise, off behaviour, agitation, fever, and itch around the bite
• progresses to furious rabies - water-provoked muscle spasms often accompanied by terror (hydrophobia)

Question 3

Pre-exposure prophylaxis

Answer 3

vets, zoo-keepers, customs workers, bat handlers, travellers in rabies for >1 month

Question 4

Treatment

Answer 4

treatment if bitten where rabies is endemic

• wash all bites meticulously with soapy water (takes 20 min and decreases incidnece by 65%)
• seek help
• watch animal to see if it dies (it is possible that it may not die of rabies before the patient does)
• if previously immunized - give vaccine (1ml IM) on days 0 and 3
• if previously unimmunized: give vaccine on days 0, 3, 7, 14 and 30 + rabies immunoglobulin
• vaccinnate staff

rabies is always fatal once symptoms start