Rabies

WMSU
By: Ben Bolay-og

WESTERN MINDANAO STATE UNIVERSITY

Definition
•Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies
virus infects the central nervous system of mammals, ultimately causing disease in the brain and death.

•According to the World Health Organization (WHO), Rabies is a viral zoonotic disease that causes
progressive and fatal inflammation of the brain and spinal cord.
FO RMS O F RABI E S
• Clinically, it has two forms:
• Furious rabies – characterised by hyperactivity and
hallucinations. Furious rabies results in signs of
hyperactivity, excitable behaviour, hydrophobia (fear of
water) and sometimes aerophobia (fear of drafts or of fresh
air). Death occurs after a few days due to cardio-
respiratory arrest.
• Paralytic rabies – characterised by paralysis and coma.
Paralytic rabies accounts for about 20% of the total
number of human cases. This form of rabies runs a less
dramatic and usually longer course than the furious form.
Muscles gradually become paralysed, starting at the site of
the bite or scratch. A coma slowly develops, and
eventually death occurs.
SIGNS AND SYMPTOMS
• I. After a rabies exposure, the rabies virus has to travel to the
brain before it can cause symptoms. This time between
exposure and appearance of symptoms is the incubation
period. It may last for weeks to months. The incubation
period may vary based on
• the location of the exposure site (how far away it is from the
brain),
• the type of rabies virus, and
• any existing immunity.

II. The first symptoms of rabies may be similar to the flu.

III. Symptoms then progress to cerebral dysfunction, anxiety,

confusion, and agitation.
CAUSATIVE FACTORS
• Rabies lyssavirus - form of virus that causes encephalitis
which affects the saliva and the central nervous system.

- bite or scratch
• from an infected animal
- rare to get infected from materials like saliva that gets
directly into the mouth, eyes, nose, or a wound.
- breathing air inside a cave that has a number of infected
bats.
- cornea transplant from undiagnosed donor
- Domestic animals like Dogs, Cats, And Cattle
- Racoons, skunks, bats, foxes, and cayotes
Causative factor
 Rabies Lyssavirus in an infected animal

Entry of the virus through bite/scratch wound

Replication of virus/ Viral Protein Production in the muscle of the wound area

Binding to nerve endings

Transport to CNS

Replication in the CNS

Inflammation and neuronal damage

Transmission to other organs

Clinical symptoms

Fatal Outcome
PREDISPOSING FACTORS
• The exposure occurs in a geographical
area where rabies is still present .
• The animal may look sick or displays
abnormal behavior .
• A wound or mucous membrane was
contaminated by the animal's saliva .
• The bite could be provoked or
unprovoked . • There are multiple bite marks
.
DIAGNOSTIC PROCEDURE
• Current diagnostic tools are not suitable for
detecting rabies infection before the onset of
clinical disease, and unless the rabiesspecific
signs of hydrophobia or aerophobia are
present, clinical diagnosis may be difficult.
Human rabies can be confirmed intra-vitam and
post mortem by various diagnostic techniques
that detect whole viruses, viral antigens, or
nucleic acids in infected tissues (brain, skin or
saliva)
• 1. . In animals, rabies is diagnosed using the
direct fluorescent antibody (DFA) test, which
looks for the presence of rabies virus antigens in
brain tissue. ·the test must include tissue from at
least two locations in the brain, preferably the
brain stem and cerebellum.
Clinical Manifestations/
Assessment
• Common symptoms of a person infected with
rabies lyssavirus are the following:
• Prodromal stage (2-10 days):
• Fever
• Headache
• Fatigue
• Loss of appetite
• Malaise
• Nausea and vomiting
Acute neurological stage (2-7
days):
• Acute neurological stage (2-7 days):
• Anxiety and restlessness
• Agitation and irritability
• Hallucinations
• Hypersalivation (excessive drooling)
• Difficulty swallowing or painful spasms of the throat
muscles
• Hydrophobia (fear of water)
• Muscle spasms, especially in the neck and throat area
• Seizures
• Weakness or paralysis
• Coma stage:
• Unresponsiveness
• Respiratory failure
• Cardiac arrest
How is it acquired?

• Rabies virus is transmitted through direct

contact (such as through broken skin or
mucous membranes in the eyes, nose, or
mouth) with saliva or brain/nervous system
tissue from an infected animal. It is also
possible, but rare, for people to get rabies
from non-bite exposures, which can include
scratches, abrasions, or open wounds that
are exposed to saliva or other potentially
infectious material from a rabid animal.
DIAGNOSTIC EXAMS/SIGNIFICANT
LABORATORY FINDINGS
[Link] fluorescent antibody (DFA)
test
[Link] transcriptase-polymerase
chain reaction (RT-PCR)
3. Virus isolation
[Link]

[Link] examination
Direct fluorescent antibody (DFA)
test
• This test is used to detect the
presence of rabies virus antigens in
skin biopsies or saliva samples. It is
the most commonly used diagnostic
test for rabies and has high
specificity and sensitivity.
Reverse transcriptase-polymerase
chain reaction (RT-PCR)
• This test is used to detect the
presence of rabies virus RNA in skin
biopsies or cerebrospinal fluid (CSF)
samples. It is a sensitive and specific
test that can detect the virus in the
early stages of infection.
Virus isolation
• This involves growing the virus in cell
cultures or animal models to confirm
the diagnosis. However, this test is
not commonly used due to safety
concerns.
Serology
• This involves testing for the presence
of rabies-specific antibodies in the
blood. However, it is not useful for
diagnosing acute rabies infection, as
it takes several weeks for the
antibodies to develop.
Histologic examination
• H. istopathologic evidence of rabies
encephalomyelitis (inflammation) in brain
tissue and meninges includes the
following:
[Link] infiltration
[Link] cuffing of lymphocytes or
polymorphonuclear cells
[Link] foci
[Link] nodules consisting of glial cells
[Link] bodies
Medical Management
• Post-exposure prophylaxis (PEP): PEP involves
administration of the rabies vaccine and rabies immune
globulin (RIG) as soon as possible after exposure to a
potentially rabid animal. This helps prevent the virus from
spreading to the brain.
• Symptomatic treatment: Once symptoms of rabies
appear, the focus of treatment is to control symptoms and
provide supportive care. This may include medications to
control seizures, pain, anxiety, and other symptoms. It is
important to keep the child as comfortable as possible.
• Respiratory support: Children with rabies may have
difficulty breathing or require respiratory support such as
oxygen therapy, intubation, or mechanical ventilation.
Medical Management
• Nutritional support: Children with rabies may have
difficulty eating or swallowing, and may require
nutritional support such as enteral or parenteral
feeding.
• Neurological monitoring: Children with rabies
require close neurological monitoring to detect any
changes in their condition. This may involve regular
neurological examinations, CT or MRI scans, and
monitoring of vital signs.
• Sedation: Children with rabies may experience
anxiety, agitation, and restlessness. Sedatives may be
used to help calm the child and manage these
symptoms.
Pharmacological Treatment
• Post-exposure prophylaxis
(PEP):Rabies vaccine: Examples
include RabAvert, Imovax Rabies,
and HDCV.
• Rabies immune globulin (RIG):
Examples include KEDRAB,
HyperRAB, and Imogam Rabies-HT.
• Symptomatic treatment: Examples
include benzodiazepines such as
lorazepam, diazepam, and
midazolam. These medications can
help manage anxiety and agitation in
children with rabies.
• Analgesics
• Examples include acetaminophen,
ibuprofen, and opioids. These
medications can help manage pain
associated with rabies symptoms.
• Sedatives
• Examples include benzodiazepines
such as lorazepam, diazepam, and
midazolam. These medications can
help manage anxiety and agitation in
children with rabies.
PREVENTIVE MANAGEMENT
• Vaccination
• Avoid contact with wild or stray
animals
• Pet vaccinations
• Animal control
• Post-exposure prophylaxis (PEP)
• Education
Complications of Rabies
• Encephalitis
• Autonomic dysfunction
• Respiratory failure
• Cardiac arrest
• Post-rabies neurological syndrome
Nursing Diagnoses
• Impaired skin integrity related to bite
wound
• Deficient knowledge related to rabies
infection and prevention
• Anxiety related to fear of developing
rabies infection
Nursing Intervention
• One possible combined nursing
intervention for these three nursing
diagnoses could be:
[Link] education and reassurance
about rabies infection and prevention
while managing the patient's bite
wound to prevent infection and
promote healing.
• Assess the patient's knowledge and understanding of
rabies infection and prevention, addressing any
misconceptions or fears.
• Provide education about the risk factors for rabies
infection, such as contact with wild animals, and the
importance of seeking prompt medical attention for
animal bites.
• Instruct the patient on proper wound care, including
cleaning and dressing the wound, monitoring for signs
of infection, and seeking follow-up care as needed.
• Offer emotional support and reassurance, addressing
the patient's anxiety about developing rabies infection.
Health Teaching
• Importance of seeking prompt medical attention
• Rabies post-exposure prophylaxis (PEP)
• Wound care: Patients should be instructed on how
to clean and care for any bite wounds they may
have.
• Avoiding contact with animals
• Signs and symptoms of rabies
• Emotional support
• Prevention