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rabies; hydrophobia

also see rabies virus Etiology: - rabies virus Epidemiology: 1) transmission can occur through the saliva of animals 2) animal hosts: a) raccoons [3] b) foxes c) coyotes d) bats e) skunks 3) 89 cases of human rabies from 1960-2018 in the U.S - 70% transmitted via bats - remainder caused by dog bite 4) only 50% of patients with rabies have known exposure; thus diagnosis should be considered in any patient with encephalitis 5) case report of rabies from organ transplantation [6] 6) outbreak among ferret-badgers 2012, Taiwan Pathology: - retrograde axonal transport of the rabies virus to the CNS resulting in viral encephalitis - putative receptor: acetylcholine receptor (muscarinic receptor) [2] - from the CNS, the virus further spreads to other organs; the salivary glands receive high concentrations of the virus, thus allowing for transmission of rabies virus through saliva - fatality can occur within anywhere from 2 days to 5 years from the time of initial infection Laboratory: - see rabies virus & ARUP consult [5] Complications: - usually, but not always fatal [6] Management: - prophylaxis after animal bite a) two shots given as soon as possible after exposure (day 0) 1] one of rabies vaccine & 2] one of rabies immune globulin - infiltrate as much of the dose as feasible in & around the wound b) 3 additional rabies vaccine shots should be administered on days 3, 7, & 14 [4] c) if rabies immune globulin is not given on day 0, it should be given by day 7 d) immunocompromised patients should receive 4 rabies vaccine shots, on days 0, 3, 7 & 14 e) persons previously immunized for rabies, should receive 2 rabies vaccine shots on days 0 & 3 e) rabies vaccine shots may be delivered to the outer aspect of the thigh in younger children & to the deltoid in older children & adults; the gluteal region should never be used [4]

Related

rabies virus

General

viral infection central nervous system (CNS) infection

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 769
  3. Journal Watch 24(1):3, 2004 MMWR Morb Mortal Wkly Rep 52:1102, 2003 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a4.htm
  4. Rupprecht CE et al Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices MMWR March 19, 2010 / 59(02);1-9 PMID: 20300058 http://cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm corresponding NGC guideline withdrawn Jan 2016
  5. ARUP Consult: Rabies Virus The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/browse-all-topics
  6. Gilbert AT et al. Evidence of rabies virus exposure among humans in the Peruvian Amazon. Am J Trop Med Hyg 2012 Aug; 87:206. PMID: 22855749 - Willoughby RE Jr. Resistance to rabies. Am J Trop Med Hyg 2012 Aug; 87:205. PMID: 22855748
  7. Centers for Disease Control and Prevention (CDC) CDC confirms rabies death in organ transplant recipient http://www.cdc.gov/media/releases/2013/s0315_rabies_organs.html
  8. Wu S et al Centers for Disease Control and Prevention (CDC) Notes from the Field: Wildlife Rabies on an Island Free from Canine Rabies for 52 Years - Taiwan, 2013. MMWR. February 28, 2014 / 63(08);178-178 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6308a4.htm
  9. Pieracci EG, Pearson CM, Wallace RM, et al. Vital Signs: Trends in Human Rabies Deaths and Exposures - United States, 1938-2018. MMWR Morb Mortal Wkly Rep 2019;68 https://www.cdc.gov/mmwr/volumes/68/wr/mm6823e1.htm
  10. Charniga K, Nakazawa Y, Brown J et al Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US. JAMA Netw Open. 2023;6(6):e2317121. PMID: 37294570 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805807
  11. Rabies, Centers for Disease Control (CDC) http://www.cdc.gov/rabies/