Rabies or Hydrophobia

Rabies or Hydrophobia

Definition:

This is an infectious and extreme deadly virus which attack central nervous system (CNS). This is caused by infected animals bite. This is specific to Domestic and wild carnivores which can accidentally through bites infect humans and mammals. Rabies kills 25 to 40 thousand usually in developing countries. Rabies is first a zoonotic disease between humans and other warm-blooded animals, particularly carnivores, but it is more an animal disease. There are many countries which had no report of this disease. I name several of them: Australia, New Zealand, Japan, Hawaii, Taiwan, Germany, United Kingdom, Ireland, Iceland, Norway, Sweden, Finland, Portugal, Greece and Cyprus. Rabies can occur in two different way:

Dog: through dogs especially stray dogs.

Other wild animals: they are host to this disease and can transmit them to cities animals like cats and dogs or domestic animals. In Europe transmission through fox was common, but it had been controlled by widely food vaccination.

Rabies is important for many reasons like:

High death rate (100 %): After symptoms are visible patient or animal will die. No treatment!

Increasing rate of animals bite: Every year healthcare must spend a big amount of money in order to purchase serums and vaccine to save vulnerable or recently bitten.

Livestock deaths and economic losses caused by this disease in animals.

Transmission:

The agent is a virus in the saliva of an infected animal that enters the human body through the damaged skin or mucous membranes. The virus migrates slowly from the bite area to the brain. Many wild animals (canine’s family) such as dogs, foxes, wolves, jackals, raccoons, and other biting animals are the natural reservoir of the virus. There are infected frugivorous, insectivorous and bloodthirsty bats In Mexico and South America. In United States, Canada and Europe infected insectivorous bats are found recently. In developing countries, dogs are the main reservoir of the virus. Rabbit, squirrels and rates are rarely infected so treating for those who may be bitten by these animals is usually not required.

The way which Disease transmitted to humans and animals are:

Biting: The main way to spread the disease is by rabid animal biting. The disease is transmitted by claws dipped in saliva containing rabies virus through the stretch especially in cats.

Skin: Rabies transmission through intact skin is not possible, but the most minor scratches or wounds in the skin can transmit the disease.

Infected mucosa: Rabies virus transmitted to humans and animals through contaminated mucus. So, apparently healthy dogs and cats that are at the end of the incubation period and symptoms are not apparent, can transmit by licking the lips, eyes and nose of kids who play with them.

Organ transplantation: exposure to rabies from organ transplant is possible. Transplant corneas from deceased who died due to a complication of undiagnosed CNS had been reported.
The virus is spread through the air in the laboratory and bat caves which is home to a large number of them are also rarely reported.

Symptoms:

From the time the virus enters the body to cause the symptoms are between 3 to 8 weeks. Incubation period can also be something from 4 day to a year. In any other contagious disease the Incubation period is not as variable and on many factors dependent as this disease. These factors include the location of the bite, severity of bite, the number of viruses who entered the body, the biting animal and how the body is protected by the clothes. Usually the hard bit and in the upper body and head takes shorter time to cause the disease than the minor or lower body area. The bites from wild animal are more dangerous than pets.

Disease with initial symptoms are Apprehension, headache, fever, malaise, fatigue and sore throat that lasts 2 to 10 days to appear. Nearly 80% of patients complain from the pain in the. More complex central nervous system symptoms are obvious which affects senses, mobility, logical and lymphatic systems. Patient is sensible to noise, light and cool air flow. Common symptoms of this disease is the fear of air (Aerophobia). Psychological symptoms are fear of death, anger, agitation and depression. Symptoms rapidly worsened and attempt to swallow liquids remained unsuccessful and then just lighting or sound of the falling water can trigger spasms of the muscles involved in swallowing. This particular sign fear of water (Hydrophobia) is only seen in humans. Symptoms can be mild, partial or complete paralysis or progressing seizure. Death often occurs during a convulsion or due to paralysis of the respiratory muscles.

Treatment:

Treatment starts after a bite by an animal suspected of having rabies or rabies virus exposure is done in several steps:

1. Wound Treatment: The most effective means is immediate washing of the animal bite or scratch with soap and water or other disinfection and then rinsed with pure water. The goal is to clear the virus from scars as much as possible. Then washing with 40 to 70 percent alcohol or aqueous solution of iodine or Poridon 0.01% to eliminate virus’s remains. Ulcers except when the beauty preservation and solidarity texture is necessary should not be sutured. If the suture is needed it should be loose to let the blood and mucus secretion be able to leave the wound.

2. Specific prophylaxis rabies immunoglobulin: after the bite human rabies immunoglobulin (HRIG) injection will neutralize the virus and rabies vaccination at another point will develop active immunity. If necessary, prescribe an antibiotics to treat bacterial infections such as penicillin and tetanus immunization should also be conducted. 

3. Development of active immunity by vaccination: vaccination conduct by injection of one cubic centimeter of the vaccine in the deltoid muscle which will be done in 5 turns. The first injection should take place as soon as possible after the bite (the first vaccination is not at the same time with immunoglobulin injections) next dose will be on days 3, 7, 14 and 30 after the first injection is given.

4. Bring the biting animal under consideration for 10 days: If the animal bitten without get Stimulated or attacked and ran away means that animal group infection is possible in that area so the vaccination program should be run. The wild carnivorous and bats bites are considered as rabies bit unless lab confirmed the absence of comorbidity in them. If the animal has not escaped and is available should be monitored for 10 days after biting. If symptoms appeared the animal should be shut down and the test should be conduct on their brain to decide about the victim treatment.

If signs of rabies had reached its advanced stages, recommended treatments are: 

1. Patient keeping: The patient should be kept in a completely quiet and dim room, and his exposure to intense light, noise and air currents which can stimulate muscle spasm or seizure must be prevented. 

2. Morphine for the muscle spasm and emotions relief​​ repeated doses of 30 to 45 mg morphine should be prescribed. It should be noted that morphine is well tolerated in these patients.

3. Feeding patients: Normal feeding is not possible. Fluids are invariably provoke spasm and the fluid should be given by other ways such as serum supplement. Urine as well needs help to be done. Adjuvant therapy during cardiopulmonary problems should be taken seriously.

Prevention:

The following recommendations are suggested for the prevention of rabies, which is very important to be followed:
- avoid keeping dogs and cats in the house, if you want to do so be sure that registration and licensing are done for dogs, use collars and vaccinate against rabies.
- Prevent children from approaching stray dogs
- Avoid keeping wild animals as pets
- Pay particular attention to the animals bite and a minor scratches and the injured person should urgently visit to the health center.
- Do tetanus vaccination on time.
- In case of any changes in animal behavior, it should be reported immediately to the vet.
- Those who are highly at risk, including veterinarians, wildlife organizations workers and the natural parks in areas where the disease is endemic or epidemic, dog quarantine staff, laboratory workers, cavers, hunters, farmers and farm workers, foresters and long stay travelers in endemic areas should be vaccinated. These vaccines is injected into muscle 3 times each a cubic centimeter in days zero (day of admission), 7, 21, or 0, 28 and 56. If there is still a risk of disease in vaccinated individuals it can be repeated every two years for a booster vaccination.
- Those who wish to travel to endemic areas and get intradermal rabies vaccine and should travel at least 30 days after the last dose of vaccine.

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