207. RABIES 2 kinds: Etiology: A.K.A.: Vital facts: Hydrophobia, Lyssa Rabies virus (A rhabdovirus of the genus lyssavirus) Urban/ Canine rabies and Sylvatic rabies Urban/ Canine Rabies: Transmitted by dogs Sylvatic Rabies: Transmitted by bats Didn’t you know? The Philippines has one of the highest prevalence rates of rabies in the world
208. RABIES Is man to man transmission possible? Can it be introduced thru breaks in the skin? MOT: Vital facts: Bite from a rabid animal Very rare Yes How about organ transplants? Yes. (Corneal transplant) Incubation period: R-a-b-i-e-s (6 weeks/ 2-8 weeks) Communicability period: 3 days before onset until the whole disease duration
209. RABIES CNS Sx (Site of bite): CNS Sx (early): Hydrophobia: Signs and symptoms: Spasms of muscles of deglutition Headache, apprehension, fever Sensory changes CNS Sx (late): Paralysis, delirium, convulsions Usual lifespan of victim w/o medical intervention: 2-6 days Usual cause of death: Respiratory paralysis
210. RABIES If it dies or shows signs of rabies, behead it and bring to doctor Submit for immunization while waiting for results If dog is not available: submit for immunization Observe the dog for 14 days, do not kill it yet. Patient may be given antibiotics/ tetanus immune globulin Wash the wound with antiseptics/ soap & water Management: Sequence of actions
211. RABIES Responsible pet ownership: Immunization of pets after 3 months of age and yearly thereafter Never allow pets to roam the streets Take good care of pets: bathe, feed, clean sleeping quarters Your pet’s action is your responsibility
In any case suspected of meningitis based on the clinical signs, a lumbar puncture is essential. Sometimes parents are afraid of the procedure and fear it is harmful to the child. It should be emphasized to them that treatment is highly dependent on CSF results. A lumbar puncture may be postponed or withheld in the following situations: presence of significant cardiac or respiratory distress and shock, sign of increased intracranial pressure, infection in the area that the spinal needle will traverse to obtain CSF, and hematologic problems such as thrombocytopenia and coagulation defects.
The following are the CSF findings that will make you confirm the diagnosis of meningitis: the CSF pressure may be elevated, there is leukocytosis with predominance of PMNs, the glucose is low, the CSF blood to glucose ratio is <0.40, and the protein is elevated. The stained smears of CSF may be (+) for bacteria. Culture of CSF should be done whenever it is available, but a negative culture does not rule out meningitis.
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