Today’s Morning Report is presented by Dr. Christopher!

 

Rabies

Background

  • One of the deadliest viruses known – case fatality rate 100%
  • Zoonotic – carried by warm blooded animals
  • Fatal if post-exposure prophylaxis is not initiated prior to symptoms
  • Majority of deaths occur in Asia/Africa

 

Pathophyisiology

  • Lyssavirus – RNA virus
  • Binds to muscle or nerve cells
  • Virus travels along nerves to the CNS and other sites to generate symptoms
  • Incubation – 2 to 12 weeks – varies depending on site of entry
  • Early symptoms – non-specific – headache, malaise, fever,
  • Late symptoms – seizures, myoclonus, agitation, depression, lethargy, heart failure
  • Hydrophobia – saliva production is greatly increased + spasms in the muscles of the throat/larynx
  • Diagnosis – clinical – PCR from skin or brain tissue

 

Prevention

  • Vaccine developed in 1885 by Louis Pasteur – harvested from infected rabbits
  • Widespread vaccination in the US has reduced deaths from 100/year to 1-2/year

 

Treatment

  • PEP should begin as soon as possible after the presumed exposure.
  • What to administer — Rabies immunoglobulin is referred to as “passive immunization”; rabies vaccine is referred to as “active immunization”.
    • Vaccine alone is given for preexposure prophylaxis
    • Post-exposure rabies prophylaxis, in previously unimmunized persons, should always include both passive and active immunization.
  • POST Exposure prophylaxis
    • Vaccine administration (4 doses) – day 0, 3, 7, 14, (28) – fifth does given if immunocompromised
      • If previously vaccinated – re-vaccinate on day 0 and day 3
      • Must have documented antibody titer – takes 7 days to mount antibody response
      • Never administer in gluteal region (low titers noted)
    • Rabies Immune Globulin (RIG)
      • Pooled plasma from hyperimmunized human donors or horses (HRIG recommended, no noted transmission of infection)
      • ½ life of 3 weeks
      • Dose – HRIG 20u/kg; Equine RIG 40u/kg
      • Should be infiltrated around the area of the wound and in an additional site other than the vaccine site
    • Wound Care – most important initial step – reduces transmission by 90%
      • Use a virucidal – betadyne
    • Other – Tetanus PPX, ABxm,mn

 

 

 

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Jay Khadpe MD

  • Editor in Chief of "The Original Kings of County"
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

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Categories: Morning Report

Jay Khadpe MD

  • Editor in Chief of “The Original Kings of County”
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

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