an quick look at a disease that is less common

2. RABIES
Acute viral disease of CNS
All mammals
RNA virus Lassavirus Rhabdovirus

5. EPIDEMIOLOGY
Worldwide distribution( Australia,Antarcitica)
Urban rabies: dogs,cats
Sylvatic rabies: foxes, wolves, bats,…
Transmission: Bite
Aerosol
Ingestion
Transplantation

7. Raccoon

8. fox

10. Bats

16. PATHOGENESIS
Live virus Epidermis, Mucus membrane
Peripheral nerve
CNS ( gray matter )
Other tissue (salivary glands,…)
centripettally
centrifugally

19. CLINICAL MANIFESTATIONS
1 – Non specific prodrome
2 – Acute neurologic encephalitis
Acute encephalitis
Profound dysfunction of brainstem
3 – Coma
4 - Death ( Rare cases  recovery )

20. CLINICAL MANIFESTATIONS
1 – Non specific prodrome
1 - 2 days  1 week
Fever, headache, sore throat
Anorexia, nausea, vomiting,
Agitation, depression
Paresthesia or fasciculations at or
Around the site of inoculation of virus.

21. CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis Phase
Furious Rabies
Dumb ( Rage tranquille )
(Landry/Guillain-Barre Syndrome)

22. CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis
1 – 2 days to < 1 week
Excessive motor activity, Excitation, Agitation
Confusion, Hallucinations, Delirium,
Bizarre aberrations of thought, Seizures,
Muscle spasms, Meningismus,
Opisthotonic posturing
Mental aberration ( Lucid period  coma )
Hypersalivation, Aphasia, Pharyngeal spasms
Incordination, Hyperactivity,

23. CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis Phase
Fever T > 40.6
Dilated irregular pupils
 Lacrimation, Salivation & Perspiration
Upper motor neuron paralysis
 Deep tendon reflexes
Extensor plantar responses ( as a rule )
Hydrophobia or Aerophobia (50 -70% )

25. DIAGNOSIS
•Laboratory finding: ( CBC, CSF )
•Exclusion of other etiologies
•Pathology:
Formation of cytoplasmic inclusions:
( Negri bodies )
( Ammon’s horn, Cerebral cortex,
Brainstem, Hypothalamus,
The Purkinje cells of cerebellum,
Dorsal spinal ganglia )

27. DIAGNOSIS
•Isolation of virus (saliva,CSF, brain )
•Serology
•Viral Ag detection ( infected tissue )
•Viral DNA detection ( PCR )

28. DIFFERENTIAL DIAGNOSIS
Other viral encephalitis
Hysteria reaction to animal bite
Poliomyelitis
Allergic encephalomyelitis ( rabies vaccine )

29. PREVENTION
Preexposure Prophylaxis
Postexposure Prophylaxis

30. HUMAN RABIES BIOLOGICS PRODUCT
Rabies immune globulin:

31. HUMAN RABIES BIOLOGICS PRODUCT
Vaccine:
Human diploid cell vaccine (HDCV)
Purified chick embryo cell vaccine (PCEC)
Purified Vero cell vaccine (PVRV)
Purified duck embryo vaccine (PDEV)

32. PREEXPOSURE PROPHYLAXIS
Veterinarian, Cave explorers,
Lab workers, Animal handlers
Active immunization (Vaccine)
On days: 0, 7, 21 (28)
Booster doses (Neutralizing Ab <1:5 )

33. POSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatment
( Tetanus & Antibiotics )
2 – Passive immunization
3 – Active immunization

34. POSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatment

37. POSTEXPOSURE PROPHYLAXIS
2 – Passive immunization
HRIG 20IU/Kg IM on day 0

38. POSTEXPOSURE PROPHYLAXIS
3 – 5 Active immunization

39. Factors that should be considered in
deciding whether or not to initiate
post-exposure treatment are:
• The nature of the contact
• The presence of rabies in the area where the contact
occurred or from which the animal involved came
• The species of the animal involved
• The vaccination and clinical status of the animal
involved, the type of vaccine used and the availability
of the animal for observation
• The results of laboratory testing of the animal for
rabies

40. Types of Exposure
The indication for post-exposure vaccination with or
without rabies immune globulin depends on the type of
contact with the rabid animal.
Types of contact are:
Category I – touching or feeding animals, licks on the
skin
Category II - nibbling of uncovered skin, minor scratches
or abrasions without bleeding, licks on broken skin
Category III – single or multiple transdermal bites or
scratches, contamination of mucous membrane with
saliva from licks; exposure to bat bites/ wildlife or scratch
by mouth by suspect wildlife.

41. Human exposure to rabies
Immediate clean wound with soap, disinfect with
alcohol.
If biting animal is vaccinated wait and observe the dog
for 10 days and if survives no need of vaccination, if sick
/ dies within 10 days then start full prophylaxis.
If stray dog, no vaccination, dog dies start complete
prophylaxis.
Consider provoked or unprovoked bite. Unprovoked bite
means rabies suspect?

42. PREVETIONIN HUMAN
Vaccination of main disease transmitters to human
Reservoir elimination and prevention of their contact
with human
Prophylaxis

43. PREVENTION IN ANIMALS