Few years back, one six year old boy presented to our tertiary care with features of altered behavior, aerophobia and hydrophobia. He had a history of dog bite one month back. His relatives had neglected treatment at that time, instead resorted to some witchcraft treatment in their locality. The patient succumbed to death in a day. It was a case of rabies with no treatment. Only due and timely vaccination can save a human life.
Rabies is a fatal disease with no cure. It is caused by Rabies virus of family Rhabdoviridae(RNA virus).
Rabid wild animals like dog, cat, monkey, jackal etc. harboring the virus can transmit the disease. The virus ascends through nerve endings. Incubation period varies according to the site of bite. The more proximity of site to brain means early fatality. Symptoms are altered behavior, photophobia, aerophobia, restlessness, irritability and finally leading to death.
Categories of bite–
I. Licks on intact skin
II. Scratches without oozing blood
III. Bites with oozing of blood, lacerated wounds.
Anti-rabies treatment involves anti-rabies vaccines and immunoglobulins. Rabies vaccines are given as per the ESSEN REGIMEN (Intramuscular) on Day 0, 3,7,14,28. Updated Thai Red cross regimen(subcutaneous) is given on Day 0, 3,7 and Day 28. Rabies immunoglobulins are equine based or human rabies immunoglobulin. The are given at the site of bite in category III bites.
Re-exposure bites are usually given two doses on Day 0, 3 if vaccinated earlier.
Management—
1. Washing the wound with running water for at least 15 minutes.
2. Anti rabies vaccine as per schedule, usually subcutaneous regimen is preferred for better immunogenicity.
3. Immunoglobulins in category III bite. Human rabies immunoglobulins are preferred over equine rabies immunoglobulin as hypersensitivity reactions are less.
4. No stitching of wound is allowed as it hastens the progress of the virus.
Misconceptions about Rabies–
1. Animal bite means harboring rabies. This is a mis-conception. Neither all animals are rabid nor all animal bites cause rabies.
2. Pet dogs if properly vaccinated against rabies are safe. We don’t have to take vaccine again and again.
3. Barking like dogs– This is not a symptom of rabies at all
4. Resorting to witchcraft treatment in rural area– As we have discussed in the above case often negligence kills. Timely vaccination only can prevent from the deadly disease.
Thanks,
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