Rabies

Question 1

Most important vector of rabies

Answer 1

Dog

Question 2

Rabies virus binds to what receptors

Answer 2

Nicotinic acetylcholine receptors at NMJ

Question 3

Most characteristic pathologic CNS finding

Answer 3

Cytoplasmic inclusions called Negri bodies within neurons

Question 4

Earliest clinical feature of rabies

Answer 4

Nonspecific prodromal manifestation

Question 5

Earliest specific neurologic symptoms

Answer 5

Paresthesia, pain or pruritus near the site of exposure

Question 6

Most common type of rabies

Answer 6

Encephalitic with early brainstem involvement but preserved consciousness

Question 7

Diagnostic of rabies

Answer 7

Rabies virus-specific antibodies

Other highly sensitive and specific tests: RT-PCR amplification, DFA testing

Question 8

Treatment of rabies

Answer 8

None

Question 9

Components of postexposure prophylaxis

Answer 9

Wound care + active immunization + passive immunization

**Not required for bites from rats, mouse, rabbits, snakes and other reptiles, birds and other avian, insects, and fish

Question 10

Passive immunization for rabies

Answer 10

Rabies immunoglobulin no later than 7 days after the 1st vaccine dose, with 20 IU/kg injected at the site of the bite then IM

Question 11

Active immunization for rabies

Answer 11

4 doses of purified inactivated rabies vaccine given IM on the deltoid on days 0, 3, 7, 14
**If previously vaccinated and completed up to at least day 7, subsequent exposures only necessitate days 0, 3

Question 12

Preexposure prophylaxis

Answer 12

Considered if with occupational or recreational risk, given rabies vaccine on days 0, 7, 21

Question 13

Category I

Answer 13

Licking on intact skin

No need to give postexposure prophylaxis

Question 14

Category II

Answer 14

Abrasions/minor scratches without bleeding or induced to bleed, nibbling of uncovered skin with or without bruising/hematoma

1. Give vaccine
2. If animal not available for observation –> give full course rabies vaccine, no need for RIG
3. If after observing animal for 14 days, animal remained healthy –> may discontinue vaccine or continue as preexposure prophylaxis
4. If after observing animal for 14 days, animal dies or becomes sick –> send animal’s head for lab examination
   a. If negative result –> may discontinue vaccine or continue as preexposure prophylaxis
   b. If positive result or no exam –> give full course rabies vaccine, no need for RIG
   * *PEP may be delayed until after observation if due to bites from previously vaccinated dog and cats for the past 2 years with last vaccination during last 12 months, provided the animal which is at least 1 yr and 6 mos old is healthy and can be observed for 14 days

Question 15

Category III

Answer 15

Transdermal bites (puncture, laceration, avulsion), abrasions/minor scratches with spontaneous bleeding, licks in broken skin, CATEGORY II located on the head and neck, exposure to rabies patients’ mucous membranes through bites or secretions, handling of infected carcass or ingestion of raw infected meat

1. Give vaccine + RIG
2. If animal not available for observation –> give full course rabies vaccine
3. If after observing animal for 14 days, animal remained healthy –> may discontinue vaccine or continue as preexposure prophylaxis
4. If after observing animal for 14 days, animal dies or becomes sick –> send animal’s head for lab examination
   a. If negative result –> may discontinue vaccine or continue as preexposure prophylaxis
   b. If positive result or no exam –> continue full course rabies vaccine