Rabies

Aka: Rabies

1. Epidemiology
   1. Responsible for 50,000 deaths worldwide per year
   2. Children under age 15 years account for 40% of cases
2. Pathophysiology
   1. Transmitted by bite of infected mammals
   2. Bats are responsible for most U.S. cases of Rabies
   3. Worldwide, Dog Bites are main vector for infection
3. Symptoms
   1. Early
      1. Local radiating Paresthesia from bite site
      2. Malaise
      3. Nausea
      4. Pharyngitis
   2. Late
      1. Restlessness
      2. Hallucinations
      3. Aerophobia and hydrophobia are pathognomonic
4. Signs
   1. Early
      1. Wound Inflammation
      2. Hyperesthesia at wound site
   2. Late
      1. Dysarthria
      2. Hoarseness
      3. Aphonia
      4. Dysphagia for fluids
      5. Shallow or irregular breathing
      6. Seizure
      7. Delirium
      8. Opisthotonos stimulated by lights or noises
      9. Hyperactive Deep Tendon Reflexes
      10. Nuchal Rigidity
      11. Abnormal Babinski reflex (Up-going toes)
   3. Terminal signs
      1. Flaccid paralysis
      2. Hospitalization <1 week after symptom onset
      3. Coma within one week of encephalopathy signs
      4. Death
5. Labs
   1. Saliva
      1. Contains virus
   2. Microscopic exam
      1. Brain and spinal cord of suspected infected animal
   3. Live Observation of suspected infected mammal
6. Management
   1. See Rabies Prophylaxis
   2. See Dog Bite
7. Prevention
   1. Rabies Vaccine
   2. Avoid bat exposure
      1. Remove bat roosts from home
   3. Pets should be vaccinated against Rabies
   4. Test for Rabies in pets who succumb to illness quickly
8. References
   1. Messenger (2002) Clin Infect Dis 35:738-47
   2. Wilde (2003) Clin Infect Dis 37:96-100