Rabies: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
Clinical rabies is incredibly rare. | ''Clinical rabies is incredibly rare.'' | ||
*Incubation period = ~20-90 days, but may be shorter or longer | |||
Incubation period ~20-90 days, but may be shorter or longer | |||
===Encephalitic form=== | |||
*Hyperexcitability, disorientation, bizarre behavior, [[hallucinations]] | |||
50% | *Autonomic dysfunction (e.g. hypersalivation) | ||
Death from various | |||
===Paralytic form=== | |||
*Paresis in bitten extremity → quadriparesis, bilateral facial weakness → coma, organ failure | |||
*Hydrophobia (50%) --> spasms of larynx, pharynx, diaphragm | |||
*Death from various complications: pituitary complications, respiratory dysfunction, cardiac dysfunction, autonomic dysfunction. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 22:06, 20 October 2018
Background
- Indication for Prophylaxis
- Bite or salivary exposure from bat, or mammalian carnivore
- Close proximity with unknown salivary exposure (e.g. live/dead bat in room)
- Prophylaxis not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases)
Clinical Features
Clinical rabies is incredibly rare.
- Incubation period = ~20-90 days, but may be shorter or longer
Encephalitic form
- Hyperexcitability, disorientation, bizarre behavior, hallucinations
- Autonomic dysfunction (e.g. hypersalivation)
Paralytic form
- Paresis in bitten extremity → quadriparesis, bilateral facial weakness → coma, organ failure
- Hydrophobia (50%) --> spasms of larynx, pharynx, diaphragm
- Death from various complications: pituitary complications, respiratory dysfunction, cardiac dysfunction, autonomic dysfunction.
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Evaluation
Algorithm for Prophylaxis
Animal was captured
Is animal dog or cat?
- Yes: Observe 10 days, if abnormal, sacrifice and treat patient with the vacc and RIG. Then patient treatment can be discontinued if the animal pathology is negative for rabies
- No: Sacrifice animal and begin RIG and vaccine. Discontinue if animal negative path for rabies
Animal was not captured
Is Animal dog or cat?
- Yes: Give vacc and RIG only if rabies risk for species in area
- No: Treat with full course vacc and RIG
Management
Immunocompetent + NOT Vaccinated
- Clean the wound (e.g. copious irrigation)
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0, 3, 7, 14[1]
- Give in deltoid (not buttock), since Ab not created in fat cells
- AND, Rabies immune globulin
- 20 IU/kg subcutaneous
- Infiltrate around wound if possible
- place remainder opposite arm of vaccine
- can administer up to 7 days after the first vaccine dose
Immunocompetent + Vaccinated
- Clean the wound (e.g. copious irrigation)
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0 and 3
- Give in deltoid (not buttock), since Ab not created in fat cells
- NO rabies immune globulin
Immuno-compromised
- Clean the wound (e.g. copious irrigation)
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0, 3, 7, 14, and 28[1]
- Give in deltoid (not buttock), since Ab not created in fat cells
- AND, Rabies immune globulin
- 20 IU/kg subcutaneous
- Infiltrate around wound if possible, except for digits and the penis
- Place remainder opposite arm of vaccine
- Can administer up to 7 days after the first vaccine dose
Disposition
See Also
References
- ↑ 1.0 1.1 Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html