Rabies

Aka: Rabies

II. Epidemiology

  1. Worldwide: Responsible for 59,000 deaths worldwide per year
    1. Children under age 15 years account for 40% of cases
  2. U.S.
    1. Eight human cases of Rabies per year
    2. Up to 8000/year in U.S. of documented cases of Rabies in animals

III. Pathophysiology

  1. Transmitted by bite of infected mammals
    1. Saliva, brain and other nerve tissue are infectious
    2. Blood, urine, and stool are not infectious
  2. Highest risk animals
    1. Bats
      1. See Bat Bite
      2. Responsible for most U.S. cases of Rabies (87% of cases 1980-2015)
    2. Dogs
      1. See Dog Bite
      2. Worldwide, these are main vector for infection
      3. Responsible for 11 of 31 U.S. human Rabies cases 2003-2016
      4. Rabies is less common in dogs (70 cases/year in U.S.)
    3. Cats
      1. See Cat Bite
      2. Most common domesticated animal with Rabies in U.S. (257 cases of cats with Rabies in 2012)
    4. Raccoons
    5. Skunks
    6. Foxes
    7. Coyotes
    8. Bobcats
    9. Woodchucks
    10. Ferrets

IV. 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

V. 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

VI. 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

VII. Management

  1. See Rabies Prophylaxis
  2. See Dog Bite

VIII. Prevention

  1. Rabies Vaccine
    1. For Rabies Postexposure Prophylaxis and preexposure prophylaxis
  2. Rabies Immunoglobulin
    1. Rabies Postexposure Prophylaxis
  3. Avoid bat exposure
    1. Remove bat roosts from home
    2. Bats trapped within a home living space are more likely to be sick (disabled navigation)
  4. Pets should be vaccinated against Rabies
    1. In U.S., of pets causing a bite evaluated in ER, only 45% of dogs and 8% of cats were vaccinated against Rabies
  5. Test for Rabies in pets who succumb to illness quickly

IX. References

  1. Swaminathan and Hope in Herbert (2018) EM:Rap 18(12): 11-2
  2. Messenger (2002) Clin Infect Dis 35:738-47 [PubMed]
  3. Wilde (2003) Clin Infect Dis 37:96-100 [PubMed]

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Related Studies

Ontology: Rabies Vaccines (C0034496)

Definition (HL7V3.0) <p>rabies vaccine, NOS</p>
Definition (MSH) Vaccines or candidate vaccines used to prevent and treat RABIES. The inactivated virus vaccine is used for preexposure immunization to persons at high risk of exposure, and in conjunction with rabies immunoglobulin, for postexposure prophylaxis.
Definition (CSP) vaccines or candidate vaccines used to prevent and/or treat rabies.
Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129) , Organic Chemical (T109)
MSH D011819
SnomedCT 333606008, 396437008
CPT 90676, 90675
HL7 90
English Rabies Human Diploid Cell Vaccine, Rabies Vaccine, Vaccine, Rabies, rabies vaccine, human diploid cell, Rabies Vaccines [Chemical/Ingredient], rabies vaccines, vaccines rabies, Vaccines, Rabies, Rabies vaccines, rabies vaccine, vaccines viral rabies, rabies vaccine (medication), rabies vaccine, human diploid, Rabies vaccine, Rabies vaccine (product), Rabies vaccine (substance), rabies, NOS, Rabies Vaccines, RABIES VACCINE
Spanish Vacunas Antirrábicas, Vacunas contra la Rabia, vacuna antirrábica (producto), vacuna antirrábica (sustancia), vacuna antirrábica
Swedish Rabiesvacciner
Czech vzteklina - vakcíny, rabies - vakcíny
Finnish Vesikauhurokotteet
Russian VAKTSINY PROTIV BESHENSTVA, ВАКЦИНЫ ПРОТИВ БЕШЕНСТВА
Japanese 狂犬病ワクチン, ワクチン-狂犬病
Italian Vaccino rabico, Vaccino rabico su cellule umane diploidi, Vaccini rabici
Croatian BJESNOĆA, CJEPIVA
Polish Szczepionki przeciw wściekliźnie
Portuguese Vacinas Antirrábicas, Vacinas contra Raiva
French Vaccins antirabiques
German Impfstoffe, Rabies-, Impfstoffe, Tollwut-, Rabiesvakzinen, Tollwutimpfstoffe, Tollwutvakzinen, Vakzinen, Rabies-, Vakzinen, Tollwut-
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Viral Infection

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