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    Rabies: By: Aids Pharmacy 3B

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    Ariston Etorma
    This document describes a case of an 11-year-old boy in the Philippines who died of rabies 11 days after being brought to the hospital with symptoms including anxiety, hallucinations, salivating, and difficulty breathing. He had been bitten by a dog 6 months prior. Rabies is a fatal viral disease transmitted through animal bites that affects the central nervous system. It manifests as either furious or paralytic symptoms and progresses rapidly to death. There is no cure once symptoms begin, making prevention through vaccination extremely important.

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    Rabies: By: Aids Pharmacy 3B

    Uploaded by

    Ariston Etorma
    21 views12 pages
    This document describes a case of an 11-year-old boy in the Philippines who died of rabies 11 days after being brought to the hospital with symptoms including anxiety, hallucinations, salivating, and difficulty breathing. He had been bitten by a dog 6 months prior. Rabies is a fatal viral disease transmitted through animal bites that affects the central nervous system. It manifests as either furious or paralytic symptoms and progresses rapidly to death. There is no cure once symptoms begin, making prevention through vaccination extremely important.

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    Rabies

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    Rabies

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    This document describes a case of an 11-year-old boy in the Philippines who died of rabies 11 days after being brought to the hospital with symptoms including anxiety, hallucinations, salivating, and difficulty breathing. He had been bitten by a dog 6 months prior. Rabies is a fatal viral disease transmitted through animal bites that affects the central nervous system. It manifests as either furious or paralytic symptoms and progresses rapidly to death. There is no cure once symptoms begin, making prevention through vaccination extremely important.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views12 pages

    Rabies: By: Aids Pharmacy 3B

    Uploaded by

    Ariston Etorma
    This document describes a case of an 11-year-old boy in the Philippines who died of rabies 11 days after being brought to the hospital with symptoms including anxiety, hallucinations, salivating, and difficulty breathing. He had been bitten by a dog 6 months prior. Rabies is a fatal viral disease transmitted through animal bites that affects the central nervous system. It manifests as either furious or paralytic symptoms and progresses rapidly to death. There is no cure once symptoms begin, making prevention through vaccination extremely important.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 12

    Rabies

    By: AIDS
    Pharmacy 3B

    Case summary
    11 year old boy was brought to a hospital in Quezon City after falling.
    Symptoms were treated, and he was released.
    -The following day

    Refuse to drink water with his medicine


    Became anxious
    Began to act up and hallucinate
    Salivating
    Difficulty of breathing

    -Two days later Fever (40.8C)


    Two episodes of cardia arrest

    TESTS
    No remarkable data obtained from a Computed Tomographic image of the brain or Cerebral spinal fluid analysis
    Skin biopsy from the nape o the neck: Viral antigen- (-) day 3; (+) day 7

    o His condition continued to deteriorate and died 11 days later


    o When the parents were questioned, the child had been bitten on the finger by a dog 6 months
    earlier while on a trip to Sagada

    Hindi kasama sa finals slide pag


    sinabi lang ni sir na related the case
    ganern
    Ante mortem before death

    Sample should be collected before rule out of rabies


    Saliva
    Using a sterile eyedropper pipette, collect saliva and place in a small sterile container which can be sealed securely. No preservatives or additional material
    should be added. Laboratory tests to be performed include detection of rabies RNA (by reverse transcription and polymerase chain reaction, RT/PCR, of
    extracted nucleic acids) and isolation of infectious virus in cell culture. Tracheal aspirates and sputum are not suitable for rabies tests.
    Neck Biopsy
    A section of skin 5 to 6 mm in diameter should be taken from the posterior region of the neck at the hairline. The biopsy specimen should contain a minimum
    of 10 hair follicles and be of sufficient depth to include the cutaneous nerves at the base of the follicle. Place the specimen on a piece of sterile gauze
    moistened with sterile water and place in a sealed container. Do not add preservatives or additional fluids. Laboratory tests to be performed include RT/PCR
    and immunofluorescent staining for viral antigen in frozen sections of the biopsy.
    Serum and cerebral spinal fluid (CSF)
    At least 0.5 ml each of serum and CSF should be collected; no preservatives should be added. Do not send whole blood. If no vaccine or rabies immune serum
    has been given, the presence of antibody to rabies virus in the serum is diagnostic and tests of CSF are unnecessary. Antibody to rabies virus in the CSF,
    regardless of the immunization history, suggests a rabies virus infection. Laboratory tests for antibody include indirect immunofluorescence and virus
    neutralization.
    Brain biopsy
    The rarity of rabies and the lack of an effective treatment make the collection of a brain biopsy for antemortem testing unwarranted; however, biopsy samples
    negative for herpes encephalitis should be tested for evidence of rabies infection. The biopsy is placed in a sterile sealed container; do not add preservatives
    or additional fluids. Laboratory tests to be performed include RT/PCR and immunofluorescent staining for viral antigen in touch impressions.
    Postmortem Samples
    In certain cases, human samples may need to be tested for rabies postmortem. Consult with the state health department before shipping any samples to the
    Rabies Laboratory at the CDC. Fresh tissue samples from the central nervous system (brain) should be submitted.
    CARDIAC ARREST VS HEART ATTACK
    -abnormal heart beating/ no warning patient lose consciousness
    -blockage of artery that supplies blood to the heart/sx: Chest pain, SOB

    Introduction

    Rabies: Latin verb to rage


    Source of great human suffering and fear since ancient times
    Deadliest infectious disease known to man
    A rapidly progressive, acute infectious disease of the central
    nervous system (CNS) in humans and animals that is caused by
    infection with rabies virus.
    2 form of rabies that progresses to death
    Encephalitic- (furious) Characterized by agitation, thrashing, biting,
    viciousness, choking, gagging, hyperventilation
    Paralytic - (dumb) May become withdrawn and seek seclusion,
    apparent depression, increased blood pressure, tachycardia, confusion,
    hallucinations, and disorientation

    Most common animal sources: bats, cats, dogs, foxes, skunks.

    Two form of rabies that progresses


    to death
    Paralytic
    Encephalitic
    (dumb)

    (furious)

    80% of patients

    Characterized by agitation, thrashing, biting, viciousness,


    choking, gagging, hyperventilation, cardiac arrhythmias

    Ends with paralysis and death.

    20% of patients

    Characterized more by paralytic symptoms, which may


    include apathy, apparent depression, increased blood
    pressure, tachycardia, confusion, hallucinations,
    disorientation.

    Ends with coma and death by respiratory failure.

    Mostoften experienced by patients whohavebeenexposed


    to the virus via bats.

    Generally survive a few days longer that Encephalitic rabies,


    but multiple-organ failure nevertheless ensures

    Pag tinanong lang!!! Hindi ko


    nilagay sa slide na.Paralytic
    Commonly mistaken as GuillainBarr syndrome
    rapid-onsetmuscle weaknesscaused by theimmune system
    damaging theperipheral nervous system.
    initial symptoms: typically changes in sensation or pain along with
    muscle weakness, beginning in the feet and hands.
    spreads to the arms and upper body with both sides being involved.
    The symptoms develop over hours to a few weeks. [2]During the
    acute phase, the disorder can be life-threatening with about 15%
    developing weakness of thebreathing musclesrequiring
    mechanical ventilation.[1]Some are affected by
    changes in the functionof theautonomic nervous system, which can
    lead to dangerous abnormalities inheart rateandblood pressure.[2]

    Epidemiology
    Rabies is a zoonotic infection that occurs in a variety of mammals
    throughout the world except in Antarctica and on some islands
    Endemic in many resource-poor and resource-limited countries
    particularly in Asia and Africa
    Eliminated from the United States and most other resource-rich
    countries
    Can be prevented by vaccination (human) and Animal
    immunization

    notes
    Zoonotic: Pertaining to azoonosis: a disease that can
    be transmitted from animals to people or, more
    specifically, a disease that normally exists in animals
    but that can infect humans
    Endemic- regularly found among particular or in a
    certain area

    Mode of
    Transmission
    Direct Contact
    Animal- Human: Bite by teeth of an infected animal
    Non-bite: Scratch of an infected animal,which introduces the virus
    through the skin or
    mucous membrane

    Animal-Animal: Animal with rabies virus attacks other animal


    Ingestion of rabid animal

    Indirect Contact
    Aerosol transmission from an infected animal, usually a bat. The virus enters
    the body through the nasal epithelium
    Tissue transplants (such as corneas) Transmission of undetected infections
    from donors

    notes
    Migration to the nervous system is via the nearest sensory or motor neuron in the ganglion at the base of the spinal
    cord or to the spinal cord itself. Once there, the virus continues to replicate. (It can then be transported back to the
    wound site or up to the brain via the central nervous system.) Axonal transport to the CNS is at a rate of 3 mm per
    hour. It is possible however, that the virus also moves across cell-to-cell junctions, and not just among nerve trunks.
    In the brain, the virus infects neurons in almost all brain regions, where it continues replication. Neuronal virus
    transmission from the periphery of the body to the brain is called "centripetal virus spread." Possible receptors for
    the virus are: acetylcholine receptors, gangliosides, and phospholipids.
    In aerosol transmission, the virus enters the body through the nasal epithelium and is subsequently transported to
    the olfactory bulb. It is thought that the virus replicates in the neurons of the olfactory bulb before spreading to other
    neurons in the brain.
    After the rabies virus infects the brain, it can continue to spread throughout the body via efferent neural pathways.
    At this stage, the virus can be found in salivary glands, taste buds, nasal cavities, tears, skin, the adrenal
    glands, pancreas, kidney, heart muscle, brown fat, hair follicles, retina, and cornea. (The virus has never been
    detected in blood or blood cells.)

    Incubation Period
    20 days to 2 months
    In some cases, the period can be as short as a few days or as long or longer than 21 years
    Incubation period can be determined by several factors
    Site of the wound bit
    o 60% if the bite is on the face
    o 15% to 40% if the bite is on the upper extremities
    o

    10% if the bite is on the lower extremities.

    Proximity to the CNS


    o Axonal transport to the CNS is at a rate of 3 mm per hour.

    Severity of the bite


    o Level 1. (pre-bite) Fearful, aggressive, or obnoxious behavior but no skin-contact by teeth.
    o Level 2. (near-bite ) Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and
    slight bleeding caused by forward, backward or lateral movement of teeth against skin, but no vertical punctures.
    o Level 3.One to four punctures from a single bite with no puncture deeper than half the length of the dogs canine teeth. Maybe lacerations
    in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (dog jumps, bites and drops to floor).
    o Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dogs canine teeth. May also
    have deep bruising around the wound

    Quantity of virus injected into the site


    Age of the patient
    Immune status of the host

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