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Understanding Rabies: Causes, Symptoms, and Treatment

Rabies is a fatal viral disease caused by the rabies virus (RABV), primarily transmitted through bites or scratches from infected animals, especially dogs. The disease progresses from initial symptoms like fever and fatigue to severe neurological issues, leading to coma and death if untreated. Prevention includes vaccinating pets and administering post-exposure prophylaxis (PEP) for those exposed to the virus.

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John Mikelangelo V. Andon
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18 views4 pages

Understanding Rabies: Causes, Symptoms, and Treatment

Rabies is a fatal viral disease caused by the rabies virus (RABV), primarily transmitted through bites or scratches from infected animals, especially dogs. The disease progresses from initial symptoms like fever and fatigue to severe neurological issues, leading to coma and death if untreated. Prevention includes vaccinating pets and administering post-exposure prophylaxis (PEP) for those exposed to the virus.

Uploaded by

John Mikelangelo V. Andon
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

Andon, John Mikelangelo V.

BSN3-E Group 4

RABIES
1. Definition
Rabies is a fatal but preventable viral disease caused by the rabies virus (RABV). It
is transmitted through direct contact (such as bites or scratches) with saliva or
nervous system tissue from an infected animal. The virus moves slowly to the brain,
causing neurological symptoms that lead to coma and death.
2. Causative Agent
The causative agent of rabies is the rabies virus (RABV), a member of the Lyssavirus
genus in the Rhabdoviridae family.
3. Mode of Transmission
1. Dog-mediated Rabies:
o In up to 99% of human rabies cases, dogs are responsible for virus
transmission. Children between the ages of 5 and 14 years are
frequent victims.
o Rabies infects mammals, including dogs, cats, livestock, and wildlife.

2. Transmission Pathways:
o Rabies spreads to people and animals via saliva, usually through bites,
scratches, or direct contact with mucosa (e.g., eyes, mouth, or open
wounds).
o Once clinical symptoms appear, rabies is virtually 100% fatal.

3. Non-Dog Sources of Rabies:


o Hematophagous (blood-feeding) bats: In the Americas, where dog-
mediated rabies is mostly controlled, bats are the primary source of
human rabies.
o Other mammals: Human deaths following exposure to foxes,
raccoons, skunks, and other wild mammals are rare. Bites from rodents
are not known to transmit rabies.
o Rare Modes of Transmission: Inhalation of virus-containing aerosols,
consumption of raw meat or milk of infected animals, or organ
transplantation.
4. Non-Transmission:
o Human-to-human transmission through bites or saliva is theoretically
possible but has never been confirmed.
4. Signs and Symptoms
1. Incubation Period:
o Typically, 2–3 months but may vary from one week to one year
depending on factors such as the location of virus entry and the viral
load.
2. Prodromal Phase (Early Symptoms 2-10 Days):
o Fever.

o Tiredness (fatigue).

o Tingling, pain, burning, itching, or numbness at the bite site.

o Sore throat, cough, or muscle pain.

o Nausea, vomiting, and diarrhea.

3. Progression:
o As the virus moves to the central nervous system, progressive and
fatal inflammation of the brain and spinal cord develops.
4. Acute Neurologic Symptoms
Types of Rabies:
o Furious Rabies:

 Agitation, aggression, and restlessness.


 Seizures, hallucinations, and delirium.
 Muscle twitching and excessive salivation.
 Hydrophobia (fear of water) and aerophobia (fear of drafts).
 Dilated or unequal pupils.
o Paralytic Rabies:

 Accounts for about 20% of human cases.


 Muscles gradually become paralyzed, starting from the wound
site. A coma slowly develops, eventually leading to death.
 This form of rabies is often misdiagnosed, contributing to
underreporting of the disease.

5. Laboratory and Diagnostic Tests


o Saliva Test: Detects rabies virus in saliva.
o Skin Biopsy: A sample from the neck is tested for rabies virus.
o Cerebrospinal Fluid Test (Lumbar Puncture): Examines
cerebrospinal fluid for signs of rabies.
o Blood Tests: Detects the presence of rabies antibodies.
o MRI: Used to observe any neurological changes in the brain.

6. Treatment
1. Vaccination of Dogs:
o Vaccinating dogs, including puppies, through mass dog vaccination
programs is the most cost-effective strategy for preventing rabies in
people because it stops transmission at its source.
2. Post-Exposure Prophylaxis (PEP):
o Rabies Vaccine: A series of four shots over 14 days (two shots if
previously vaccinated).
o Human Rabies Immune Globulin (HRIG): Administered around the
wound to provide immediate antibodies for those not previously
vaccinated.
o Categories of Contact with Suspect Rabid Animal:

 Category I: Touching or feeding animals, animal licks on intact


skin (no exposure).
 Washing of exposed skin surfaces, no PEP.
 Category II: Nibbling of uncovered skin, minor scratches or
abrasions without bleeding (exposure).
 Wound washing and immediate vaccination.
 Category III: Single or multiple transdermal bites or scratches,
contamination of mucous membrane or broken skin with saliva
from animal licks, exposure due to direct contact with bats
(severe exposure).
 Wound washing, immediate vaccination, and
administration of rabies immunoglobulin/monoclonal
antibodies.
o Vaccine Administration:

 WHO recommends moving from intramuscular (IM) to


intradermal (ID) administration of human rabies vaccines to
reduce costs by 60–80% without compromising safety or
efficacy.
7. Nursing Management/Care
 Immediate Actions for Exposure:
o Clean the wound thoroughly with soap and water.

o Notify healthcare providers and report to animal control if a


wild or aggressive animal is involved.
 Vaccination Support:
o Administer and monitor post-exposure prophylaxis (PEP).

o Educate the patient about the importance of completing the


vaccine series.
 Patient Education:
o Inform the patient about avoiding contact with wild animals.

o Encourage regular rabies vaccination for pets to reduce


exposure risk.
 Monitoring:
o Observe for early symptoms such as fever and localized
tingling.
o Provide comfort care and support during treatment for mild
vaccine-related side effects (e.g., itching or pain at the
injection site).

Common questions

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Post-exposure prophylaxis (PEP) involves washing the wound thoroughly with soap and water, administering a series of rabies vaccine shots (four doses over 14 days or two if previously vaccinated), and in cases of severe exposure, providing Human Rabies Immune Globulin (HRIG) around the wound. Exposure severity is categorized into three levels: Category I involves no exposure, Category II involves minor scratches, and Category III involves transdermal bites or mucosal contact with saliva. WHO recommends intradermal administration of the rabies vaccine to reduce costs while maintaining effectiveness .

Rabies diagnosis involves several methods: a saliva test to detect the virus, a skin biopsy from the neck, cerebrospinal fluid examination via lumbar puncture for rabies signs, antibody detection in blood tests, and MRI to observe neurological changes in the brain. These methods aid in confirming rabies in symptomatic individuals .

Furious rabies is characterized by symptoms such as agitation, aggression, restlessness, seizures, hallucinations, and delirium. Patients may exhibit hydrophobia and aerophobia, dilated pupils, and excessive salivation. Paralytic rabies, which accounts for about 20% of cases, involves gradual muscle paralysis starting from the wound site, leading to a coma and eventual death. This form can be misdiagnosed due to its less visible symptoms compared to furious rabies .

Initially, rabies presents a prodromal phase with symptoms like fever, fatigue, sore throat, and localized sensations at the bite site. Progressing to the acute neurologic phase, it manifests as either furious rabies, with agitation and hallucinations, or paralytic rabies, with muscle paralysis. In both cases, the disease ultimately progresses to coma and death, as it causes fatal inflammation of the brain and spinal cord .

Mass vaccination of dogs is the most cost-effective strategy for preventing rabies within communities, as it curtails transmission at its primary source. This approach has been pivotal in regions that managed to control dog-mediated rabies. Public education on avoiding contact with wild animals and the importance of pet vaccination also plays a critical role in community-level prevention .

The incubation period of rabies typically ranges from 2 to 3 months but can vary between one week to one year. The variation depends on factors such as the location of virus entry, with bites closer to the brain potentially leading to a shorter incubation, and the viral load transferred during exposure .

Rabies transmission primarily occurs through dog bites, accounting for up to 99% of human rabies cases globally. In regions where dog-mediated rabies is controlled, such as the Americas, bats become the primary source of human rabies. Additionally, rare cases of transmission can arise from exposure to wild mammals like foxes, raccoons, and skunks, although transmission from rodents is not known. The virus spreads through saliva via bites, scratches, or direct contact with mucosal surfaces or open wounds .

Non-canine sources primarily include hematophagous bats, especially in the Americas where dog-mediated rabies is rare. Other mammals like foxes, raccoons, and skunks contribute occasionally, while transmission from rodents is not known to occur. Human cases from these sources are much less frequent than dog-related rabies, highlighting the importance of geographical and ecological context in rabies transmission .

The WHO recommends switching from intramuscular (IM) to intradermal (ID) administration for rabies vaccines to significantly reduce costs, by as much as 60–80%, while maintaining the vaccine's safety and efficacy. Intradermal administration uses less vaccine material per dose, thus optimizing resource use and making vaccination strategies more sustainable .

Following infection, rabies spreads to the central nervous system, causing inflammation of the brain and spinal cord. This results in two types of symptoms: furious and paralytic rabies. Furious rabies symptoms include aggression and hydrophobia, while paralytic rabies includes muscle paralysis. Both forms lead inevitably to coma and death once clinical symptoms appear, making it virtually 100% fatal if untreated .

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