RABIES-

Rabies is a highly progressive and acute infectious disease that occurs due to rabies virus and it mostly affects the central nervous system of the patient.

This virus is transmitted to human beings through the bite of infected animals.

It is a deadly disease and most of the deaths occur in Asian and African countries.

Animals such as Dogs, cats, raccoons, skunks, foxes, and bats are known to carry rabies virus.

PATHOGENESIS –

If a person gets bitten by an infected animal then the incubation period can be from a few weeks to up to 3 months which means that rabies symptoms can appear sometimes as late as three months.

After the bite from the animal, the virus travels through the peripheral nerves towards the spinal cord of the human body which means that the virus has entered the CNS (central nervous system).

Neurons are affected very quickly by this virus. After the virus affects the CNS, then it moves through the sensory and autonomic nervous system to reach the other organs such as the heart, salivary gland, skin, and adrenal gland which leads to the spread of infection in these organs.

SYMPTOMS OF RABIES-

It can be divided into 3 phases – Prodromal, Neurological, and coma stage.

1. PRODROMAL-This stage includes symptoms like fever, headache, body pain, nausea, and vomiting. Pain at the site of the bite is also present.
2. NEUROLOGICAL– 80% of patients get encephalitic type of neurological symptoms which include confusion, hallucination, seizures, excessive saliva secretion, increase in heart rate, hydrophobia (scared of drinking water), acrophobia (scared of air) and 20% get paralytic symptoms in which patients suffer from muscular and facial weakness.
3. COMA- In this stage, the patient becomes very serious and it is very difficult to save the patient.

LABORATORY INVESTIGATION-

1. DFA- Direct Fluorescent antibody testing is a highly sensitive and specific test. It is performed on the suspected animal brain tissue sample.
2. RT-PCR- It is a highly sensitive and specific test that can detect rabies virus RNA.
3. Rabies virus antibodies- It is not found in all patients and usually appears late in diseased patients and hence is of not much significance.
4. CBC- Complete blood count is normal in rabies-infected patients.
5. MRI Brain- MRI can show signal abnormalities in the brainstem.

MANAGEMENT OF RABIES-

1. Wound care- It is one of the most important parts of treatment for a patient who has been bitten by an animal. Wash the wound with soap and running water immediately and thoroughly.
2. Wound debridement- The devitalized tissue should be debrided.
3. Tetanus- It is important to give prophylactic tetanus injections to patients who suffer from animal bites or scratches.
4. Antibiotics- If the doctor feels that the wound is infected then they can start the patient with antibiotics. It should be kept in mind that the antibiotics should be given by the doctor only and patients should not initiate any antibiotic treatment by themselves.
5. Rabies Immunoglobulin- It should be given to patients who are not previously immunized and this immunoglobulin should not be given after 7 days of the first vaccine because antibodies production is already started.
6. This immunoglobulin dose is about 20 IU/KG and it should be tried that the whole those should be infiltrated around the wound for maximum effect. Diluting the immunoglobulin can help to cover the large area of the wound.
7. If the bite involves the mucus membrane then the whole immunoglobulin should be given intra-muscularly to the patient.
8. Never give Rabies vaccine and rabies immunoglobulin at the same site of the body or from the same injection.
9. Vaccine- Four doses of rabies vaccines are given to the patient, the first dose is given as soon as the patient suffers from the bite by a suspected animal, and after that, the doses are given on the 3rd day, 7th and 14th day. vaccine should be given in the deltoid muscle for adult patients and for babies, it can be given on the anterolateral aspect of the thigh.
10. Pregnant ladies can also be immunized with the vaccine.
11. supportive treatment should be given to the patient.

SUMMARY-

It is a dangerous disease and if not treated properly then it can lead to serious complications and even death of the patient. Animals such as dogs, cats, raccoons, and bats are some of the animals that can carry this virus. Symptoms of this infection can range from fever, and body pain to encephalitis type such as confusion, hallucination, high heart rate, and anxiety.

Wound care is very important after the animal bite especially it should be done with soap to prevent the spread of infection. Medical attention should be given to the patient as soon as possible and in case of suspicion, the patient should be started with immunoglobulin and vaccine.

Don’t give rabies vaccine in the gluteal region as this reason has more fat and chances of vaccine reaching the muscles decrease and it can lead to vaccine failure.

Take care and stay healthy.