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Rabies

Rabies is a serious neurological disease caused by the rabies virus that is nearly always fatal. Rabies virus is present in wild animals like bats, skunks, raccoons, foxes and coyotes. Domestic animals like dogs and cats contract rabies when they come in contact with wild animals. Human beings contract rabies most commonly from the bite of domestic animals, primarily dogs. However it can also be contracted by inhaling dusty air in bat infested caves.

All dogs and cats in the developing world are considered to be infected with the rabies virus.

In the United States nearly 1/3 of all rabies cases were acquired overseas.

What if an animal bit me?

If bitten by wild or domestic animals in the developing world or if suspicious that you may have been bitten by a rabid animal you should:

Vigorously wash the wound with soap and water or disinfectant; this decreases the risk of rabies by 90% in animal models.

Apply alcohol or iodine solution to the wound after washing it.

Get to a medical facility and have the wound cleansed again under medical supervision.

If you have NOT had the rabies vaccine in the previous 3 years, you should have Human Rabies Immune Globulin administered at a dose of 20IU/kg into the wound and have the Rabies Vaccine series given on days 0, 3, 7, 14 and 28.

If you have HAD the rabies vaccine in the previous 3 years, you should be given 2 doses of the Rabies Vaccine on days 0 & 3 you do not need Human Rabies Immune Globulin.

Up date your tetanus if not done in the past 5-10 years

Start on a 7-day course of a broad-spectrum antibiotic that covers anaerobic and aerobic bacteria like Augmentin or Doxycycline.

Unless absolutely required and unavoidable for medical reasons, the wound should NOT be sutured or closed because of the risk of serious infection.

Where does it occur?

The rabies virus is present worldwide. However, human cases primarily occur in developing nations from domestic animal bites. Map

How is it transmitted?

The rabies virus is present in saliva and transmission occurs primarily through animal bites. It can also be transmitted by scratches from infected animals, exposure to animal saliva on open wounds or rarely from airborne exposure in bat infested caves.

Is it contagious from person to person?

While it is theoretically possible, rabies is not considered contagious from person to person.

What is the risk for travelers?

For travelers dog bites are the single most important risk factor in contracting rabies. However any wild or domestic animal bite in the developing world should be considered as potentially high risk for contracting rabies.

How soon after exposure will one develop symptoms?

Symptoms usually develop anywhere from 2 weeks to 2 months after exposure.

What are the signs and symptoms?

Initial symptoms are vague and can include fever, chills, sore throat, cough, abdominal pain, vomiting and diarrhea.

Pain, burning or tingling sensation in the area of the bite could be the first specific symptom that suggests rabies. Infected individuals develop a sense of apprehension or doom, anxiety and nervousness. Individuals may be very excitable to noise or light. They also develop complaints of headache, stiff neck, nausea, vomiting and fever.

The progression of neurologic infection can result in a furious state characterized by confusion, delirium, hyperactivity, thrashing, running etc that alternates with periods of calm. Intense spasms of the swallowing muscles can be set off by the sound, sight or thought of water (hydrophobia) or by blowing air on the individuals face (aerophobia). They also have fever, elevated blood pressures, rapid heart beat and excessive salivation.

Neurologic progression can also be characterized by a state of paralysis where the bitten extremity is the worst affected but there is progressive paralysis of all other muscle groups.

Individuals progress to delirium, seizures, coma and death over a 7-10 day period.

Are there any lab tests to diagnose the illness?

Diagnosis is usually based on symptoms and history of animal bite. Laboratory diagnosis is difficult and cumbersome and involves biopsy of the skin in the back of the neck, isolation of the virus from saliva or spinal fluid in cell cultures or more commonly neutralizing antibody test from spinal fluid on cell culture.

Is there any treatment?

There is no specific antiviral treatment for rabies; supportive care is standard practice. Rabies vaccine and immune globulin need to be given prior to the onset of symptoms to be of value. Use of steroids seems to increase mortality.

What preventive measures can be taken?

Avoid contact with wild or domestic animals in the developing world. You can pet ‘duffy’ ‘buffy’ ‘muffy’ and ‘rufus’ when you get back.

Rabies vaccinations are recommended for travelers with exposure risk: veterinarians, animal handlers, field biologists, missionaries, spelunkers (cave enthusiasts) etc.

If you intend to do prolonged activities like biking, hiking and camping (chased by stray dogs who don’t like gringos) in countries with lack of available vaccines and immune globulins; you should consider pre-travel vaccination.

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