Rabies (hydrophobia) is an acute central nervous system (CNS) infection. It usually is transmitted by an animal bite and is almost always fatal after symptoms occur. Fortunately, immunization that begins soon after infection may prevent fatal CNS invasion.
Increased domestic animal control and vaccination in the United States have reduced cases of rabies in humans. Consequently, most human rabies can be traced to dog bites that occurred in other countries or bites from wild animals, such as raccoons.
Rabies is caused by the rabies virus, a rhabdovirus. The rabies virus is transmitted to a human from the bite of an infected animal through the skin or mucous membranes. The virus begins replicating in the striated muscle cells at the entry site and spreads along the nerve pathways to the spinal cord and brain, where it replicates. Finally, it moves through the nerves into other tissues, including the salivary glands. Airborne droplets and infected tissue transplants occasionally can transmit the virus. The incubation period is hours to weeks.
Signs and symptoms
In developing countries, the disease is often diagnosed on the basis of what the patient's family can relate and the characteristic disease picture.
In developed countries, the doctor will confirm the diagnosis by sending tissue samples to a laboratory, where the virus can be detected. In animals, the diagnosis is made by detecting the virus in samples of brain tissue from the dead animal.
Immunization as soon as possible after exposure and meticulous wound care are the treatments for rabies.
Before performing wound care, remember to put on gloves to avoid contact with infected blood. Thoroughly wash all wounds and abrasions with soap and water. Check the patient's immunization status, and administer tetanus-diphtheria prophylaxis, if needed. Take measures to control bacterial infection as ordered. If the wound requires suturing, special techniques may be used to ensure proper wound drainage.
Although no specific drugs are available to treat rabies, post exposure prophylaxis usually is successful in preventing disease when used appropriately during the rabies incubation period. Treatment is mainly supportive, with special attention given to the cardiovascular and respiratory systems.
Prevention depends upon enforcement of the following public health policies:
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