Tuesday, November 18, 2014

Rabies

Rabies



DEFINITION
Rabies is a fatal illness caused by the rabies virus and transmitted to humans by the bite of an infected animal.


PHYSICAL FINDINGS AND CLINICAL PRESENTATION
● Incubation period of 10 to 90 days
1. Shorter with bites of the face
2. Longer if extremities involved

● Prodrome
1. Fever
2. Headache
3. Malaise
4. Pain or anesthesia at exposure site
5. Sore throat
6. GI symptoms
7. Psychiatric symptoms

● Acute neurologic period, with objective evidence of CNS
involvement
1. Extreme hyperactivity and bizarre behavior alternating
with periods of relative calm
2. Hallucinations
3. Disorientation
4. Seizures
5. Paralysis may occur
6. Spasm of the pharynx and larynx, accompanied by severe pain, caused by drinking
7. Fear elicited by seeing water
8. Paralysis
9. Coma

● Possible death from respiratory arrest

CAUSE
● Rabies virus
● Cases in the United States are associated with bats, raccoons,
foxes, and skunks
● In 8 of the 32 cases occurring in the United States since
1980, there was a history of exposure to bats without an
actual bite or scratch.
● Imported cases are usually associated with dogs. Figure describes the pathogeniesis of rabies.
● Unusual acquisition:
1. Via organ transplantation
2. Via aerosol transmission in laboratory workers and spelunkers

DIFFERENTIAL DIAGNOSIS
● Delirium tremens
● Tetanus
● Hysteria
● Psychiatric disorders
● Other viral encephalitides
● Guillain-Barré syndrome
● Poliomyelitis

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