Rabies is a viral encephalitis, transmitted through the saliva of infected bats and certain other infected mammals. Symptoms include depression and fever, followed by agitation, excessive salivation and hydrophobicity. The diagnosis is made by a serological test or biopsy. Vaccination is indicated for people with high risk of exposure. A post-exposure prophylaxis includes wound cleaning and a passive and active immune prophylaxis and protects you if promptly and carefully conducted before human rabies. Otherwise, the disease is almost always fatal. The treatment is symptomatic.
Rabies causes> 55,000 human deaths worldwide each year, mostly in Latin America, Africa and Asia, where canine rabies is endemic. In the US, the vaccination of domestic animals has reduced cases of rabies in people <3 per year, most of which are transmitted by infected bats. Infected raccoons, skunks and foxes can transmit rabies as well.
Rabies is a viral encephalitis, transmitted through the saliva of infected bats and certain other infected mammals. Symptoms include depression and fever, followed by agitation, excessive salivation and hydrophobicity. The diagnosis is made by a serological test or biopsy. Vaccination is indicated for people with high risk of exposure. A post-exposure prophylaxis includes wound cleaning and a passive and active immune prophylaxis and protects you if promptly and carefully conducted before human rabies. Otherwise, the disease is almost always fatal. The treatment is symptomatic. Rabies causes> 55,000 human deaths worldwide each year, mostly in Latin America, Africa and Asia, where canine rabies is endemic. In the US, the vaccination of domestic animals has reduced cases of rabies in people <3 per year, most of which are transmitted by infected bats. Infected raccoons, skunks and foxes can transmit rabies as well. Rabid animals transmitted the infection to their saliva, usually in a bite. Rarely, the virus can enter through a superficial skin lesion or through the mucous membranes of the eyes, nose and mouth. The virus travels from the point of entry on the peripheral nerves to the spinal cord (the brain stem or if the patient was bitten in the face), then to the brain. It then spreads to the central nervous system via the peripheral nerves in other areas of the body. The involvement of the salivary glands and oral mucosa is responsible for transferability. Symptoms and complaints at the bite site may develop pain or paresthesias. The speed of progress depends on the viral inoculum and close the wound from the brain. Incubation with an average of 1-2 months, but can be> 1 year. The initial symptoms are non-specific: fever, headache and malaise. Within days encephalitis ( “rage” in 80% of patients) or paralysis ( “silent rage” in 20% of cases) developed. The encephalitis caused restlessness, confusion, agitation, bizarre behavior, hallucinations and insomnia. Saliva flow is excessive, and drink attempts to call painful spasms of the laryngeal and pharyngeal muscles out (hydrophobicity). In the paralytic form an ascending paralysis developed to quadriplegia without delirium and hydrophobicity. Diagnostic skin biopsy Sometimes PCR testing of fluid or tissue samples suspected rabies in patients who have a encephalitis or ascending paralysis and have a history of an animal bite or exposure to bats. Bat bites can be superficial and be overlooked. A direct fluorescent antibody examination of a biopsy sample obtained from the skin of the neck is the diagnostic test of choice. The diagnosis can be made by a PCR test of cerebrospinal fluid, saliva or tissue. Serum and CSF samples are tested for antibodies to rabies. CT, MRI and EEG are normal or show nonspecific changes. Symptomatic treatment Treatment Treatment is symptomatic and includes a strong sedation (z. B. with ketamine and midazolam) and disease modifying measures. Death usually occurs within 3-10 days after onset of symptoms. A few patients have survived; many had received an immune prophylaxis before the onset of symptoms. It is demonstrated that the administration of rabies vaccine and immunoglobulin after the development of clinically manifest Rabies can cause a much more rapid deterioration. Experimental therapies with ribavirin, amantadine, interferon alpha and other drugs are sometimes desperately trying (s. Care of Rabies protocol). Prevention Rabid animals can often be recognized by their strange behavior; they may be agitated and aggressive, weak or paralyzed and also the fear of people can lose. Nocturnal animals (eg. As bats, skunks, raccoons) can be on the road during the day. Bats can make unusual sounds and have difficulty flying. One should not approach an animal in which rabies is suspected. The local health authorities should be turned on to remove the animal. Preexposure The human diploid-rabies vaccine (HDCV) is safe and is recommended for pre-exposure prophylaxis in individuals at high risk; including veterinarians, animal handlers, speleologists, workers who deal with the virus, and travelers to endemic areas. There are i.m. total of three 1-mL doses on each of days 0 and 7 and between day 21 and day 28 gegeben.Postexposition A rabies exposure is suspected in a bite passes through the skin, or to any contact between the mucous membrane or broken skin and animal saliva. If exposure occurs, prompt, energetic prophylactic measures should be taken, which can almost always prevent rabies in humans. The wound is immediately cleaned and rinsed thoroughly with soap and water or benzalkonium chloride. Depth, stitch-shaped wounds are flushed with soapy water under moderate pressure. The wounds are usually left open. A post-exposure prophylaxis (PEP) with rabies vaccine and immune globulin (RIG) is administered, depending on the animal that has bitten, and on the circumstances (see table: rabies post-exposure prophylaxis). The PEP is started, and the brain of the animal is tested for the virus. Local or state health authorities usually conduct the investigation and to initiate further treatment measures. Rabies post-exposure prophylaxis species assessment and disposal of the animal post-exposure prophylaxis * skunks, raccoons, bats, foxes, and most other carnivores valid until proven otherwise by negative laboratory tests as rabid Consider immediate vaccination and rabies immunoglobulin. Dogs, cats and ferrets Healthy and available for 10 days for observation Begin no immune prophylaxis, unless the animal develops symptoms of Tollwut.§ Unknown (escaped) Consult representatives of the public Gesundheitswesens.¶ Rabid or suspected rabid Vaccinate immediately. Consider rabies immunoglobulin. Livestock, small rodents (eg. As squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice), lagomorphs (rabbits, hares), large rodents (eg. As marmots, beavers) and other mammals individual assessment Consult representative public health. An immune prophylaxis is almost never required for bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice and other small rodents or lagomorphs. * All bites should be washed immediately with soap and water. Because it is difficult to recognize bat bites, vaccination is indicated when a bite is probable, that if a person with a bat in the room wakes up or a small child is found with a bat. The animal should be euthanized and tested as soon as possible. A retention for observation is not recommended. The vaccine is issued if rabies immunofluorescence negative tests in animals. § If the animal remains healthy during the 10-day observation period, it was not infectious at the time of the bite. However, treatment with rabies immune globulin (RIG) and human diploid-rabies vaccine is started (HDCV) at the first sign of rabies in dogs, cats or ferrets that have bitten someone. An animal with symptoms should be immediately euthanized and examined. ¶ If expert advice on site is unavailable and rabies seems possible immediate vaccination should be considered. Adapted from rabies prevention-United States, 1999: Recommendations of the Immunization Practices Advisory Committee (ACIP). Morbidity and Mortality Weekly Report 48 (RR-1): 1-21, 1999. For PEP RIG is infiltrated 20 I.U./kg for passive immunization around the wound. If the injection volume for distal regions (z. B. Finger, nose) is too large, a part of the RIG i.m. administered. This treatment is accompanied by HDCV for active immunization. HDCV is i.m., in a series of four 1-ml injections given (vorzusweise into the deltoid muscle), starting on the day of challenge (day 0) to a limb that has not been used for the RIG. Subsequent injections take place on days 3, 7 and 14; immunosuppressed patients receive a fifth dose at 28 days. Rarely, a serious systemic or neuroparalytic reaction; then the completion of vaccination against the patient’s risk should be weighed for the development of rabies. To assess the risk in the termination of the vaccination, the Tollwutantikörpertiter be determined. The PEP for a person who has been vaccinated against rabies earlier, there i.m. in a 1 ml injection of HDCV on days 0 and 3, but not RIG is given. Conclusion Worldwide, rabies causes each year tens of thousands of deaths, mostly in Latin America, Africa and Asia, where canine rabies is endemic. In the US, only a few people a year die from rabies; it is usually transmitted by bats, but possibly also by raccoons, skunks and foxes. Pain and / or paresthesia at the bite site, followed by encephalitis (restlessness and agitation caused) or ascending paralysis. Remove a skin biopsy of the neck or perform a PCR of saliva, cerebrospinal fluid or tissue through when patients have an unexplained encephalitis or ascending paralysis. Treat them the patient supportive. Administer high-risk individuals (eg. As veterinarians, animal handlers, speleologists, workers who deal with the virus, and travelers to endemic areas), the rabies vaccine before exposure. Clean thoroughly after exposure the wounds and remove debris, then enter the rabies vaccine and rabies immunoglobulin.