Rabies alert
 

FYI
Published today:
Compendium of Animal Rabies Prevention and Control, 2005*

I moved this here. It is more appropriate in this forum.

now you'll get me started.....
I reported the first case of a rabid donkey to human bite in 1998 to the CDC (see pic). Patient was bitten by her pet donkey that she thought was choking on an apple, banging its head on the tree, frothing at the mouth. It bit her 26 times and bit through her left upper arm...she was missing bone, artery and vein, nerve, muscle and all that was holding the arm on was a piece of triceps and some skin. Finished the amputation in the OR, treated her with the vaccine and she did well.
When I left Miami (trauma fellowship) I thought I had seen it all....I was sorely mistaken!!!
If anyone want the Tx regiment, I'll post it.

Welcome, JAG. Your kid is not bad.

i like to

Frank

Need to consider rabies as a diagnosis in any case presenting with the acute onset and rapid progression of compatible neurologic signs, regardless of the patients report of an animal bite


If animal not available, must decide on Rx by probability of exposure
leads to overtreatment
Really have to play Dirty Harry.....So, ---- , do you feel lucky today ??

if patient not previously vaccinated:
local wound cleansing with soap and water
HRIG (human rabies immune globulin)
20 IU/kg :as much as possible infiltrated into and around the wound, rest IM distant from vaccine site (different syringes)
Vaccine: 1 mL IM deltoid on days 0, 3, 7, 14, 28

If previously vaccinated:
local wound cleansing
No HRIG
Vaccine: 1 mL IM deltoid on day 0 and 3

these regiments include children

Symptoms:
Prodromal period of malaise, fatigue, fever, headache, irritability, depression, nausea, sore throat, anorexia, pain or paresthesia at bite site
progression of symptoms
hyper, seizures, aggression
progressive lethargy, ascending paralysis, cranial nerve palsies
Severe spasms of pharyngeal and respiratory muscles
Odynophagia = hydrophobia
Aerophobia = choking and pharyngeal spasm when air blown in face
Changes in behavior: bad to good, good to bad
Excessive salivation

swatsurgeon (or anyone), how long can a human being go before receiving treatment and still survive? I'll confess that my image of rabies is either be treated within a day or so or die.

After an incubation period of several weeks to months, the virus passes via the peripheral nervous system and replicates in the central nervous system. Rabies virus can then be disseminated to salivary glands and other organs via neural innervation (3). Rabies can be prevented by administration of rabies postexposure prophylaxis (PEP) (4), which is highly effective in preventing rabies when administered before onset of clinical signs.
The closer to the central nervous system the bite is (head vs. foot) will also corrolate time to symtoms.

how do vac. and non-vacc. do in PEP program?

Related follow-up
 

Here is a more general follow-up to this thread.

Compendium of Measures To Prevent Disease Associated with Animals in Public Settings, 2005

Although this is written with the "Public Settings" in mind, you will note that the recommendation to wash hands is the single most important prevention step for reducing the risk for disease transmission. That recommendation is important to remember regardless of the setting.

Regards to all.