Download - Rabies..(1)
EPIDEMIOLOGYEPIDEMIOLOGYWorldwide distributionWorldwide distribution( ( Australia,AntarciticaAustralia,Antarcitica))Urban rabies: dogs,catsUrban rabies: dogs,catsSylvatic rabies: foxes, wolves, batsSylvatic rabies: foxes, wolves, bats,…,…Transmission: BiteTransmission: Bite AerosolAerosol Ingestion Ingestion TransplantationTransplantationEPIDEMIOLOGY IN IRANEPIDEMIOLOGY IN IRAN
PATHOGENESISPATHOGENESISLive virusLive virus Epidermis, Mucus membrane Epidermis, Mucus membrane
Peripheral nervePeripheral nerve
CNS ( gray matter )CNS ( gray matter )
Other tissue (salivary glands,…)Other tissue (salivary glands,…)
centripettally
centrifugally
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
1 – Non specific prodromeNon specific prodrome
2 – Acute neurologic encephalitis2 – Acute neurologic encephalitis Acute encephalitisAcute encephalitis Profound dysfunction of brainstemProfound dysfunction of brainstem
3 – Coma3 – Coma
4 - Death 4 - Death ( Rare cases ( Rare cases recovery ) recovery )
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS1 – Non specific prodrome Non specific prodrome 1 - 2 days 1 - 2 days 1 week 1 weekFever, headache, sore throatFever, headache, sore throatAnorexia, nausea, vomiting, Anorexia, nausea, vomiting, Agitation, depressionAgitation, depressionParesthesia or fasciculations at orParesthesia or fasciculations at or Around the site of inoculation of virus. Around the site of inoculation of virus.
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS2 – Acute Neurologic Encephalitis Phase2 – Acute Neurologic Encephalitis Phase
Furious RabiesFurious Rabies
Dumb ( Rage tranquille )Dumb ( Rage tranquille ) (Landry/Guillain-Barre Syndrome)(Landry/Guillain-Barre Syndrome)
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS2 – Acute Neurologic Encephalitis 2 – Acute Neurologic Encephalitis 1 – 2 days to < 1 week1 – 2 days to < 1 weekExcessive motor activity, Excitation, AgitationExcessive motor activity, Excitation, AgitationConfusion, Hallucinations, Delirium, Confusion, Hallucinations, Delirium, Bizarre aberrations of thought, Seizures,Bizarre aberrations of thought, Seizures,Muscle spasms, Meningismus, Muscle spasms, Meningismus, Opisthotonic posturingOpisthotonic posturing Mental aberration ( Lucid period Mental aberration ( Lucid period coma ) coma ) Hypersalivation, Aphasia, Pharyngeal spasmsHypersalivation, Aphasia, Pharyngeal spasmsIncordination, Hyperactivity, Incordination, Hyperactivity,
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS2 – Acute Neurologic Encephalitis Phase2 – Acute Neurologic Encephalitis PhaseFever T > 40.6 Fever T > 40.6 Dilated irregular pupils Dilated irregular pupils Lacrimation, Salivation & PerspirationLacrimation, Salivation & PerspirationUpper motor neuron paralysisUpper motor neuron paralysis DDeep tendon reflexeseep tendon reflexesExtensor plantar responses ( as a rule )Extensor plantar responses ( as a rule )Hydrophobia or Aerophobia (50 -70% )Hydrophobia or Aerophobia (50 -70% )
DIAGNOSISDIAGNOSIS•Laboratory finding: ( CBC, CSF )Laboratory finding: ( CBC, CSF )•Exclusion of other etiologiesExclusion of other etiologies
•Pathology:Pathology: Formation of Formation of cytoplasmic inclusionscytoplasmic inclusions: : ( Negri bodies )( Negri bodies ) ( Ammon’s horn, Cerebral cortex,( Ammon’s horn, Cerebral cortex, Brainstem, Hypothalamus, Brainstem, Hypothalamus, The Purkinje cells of cerebellum, The Purkinje cells of cerebellum, Dorsal spinal ganglia )Dorsal spinal ganglia )
DIAGNOSISDIAGNOSIS•Isolation of virus (saliva,CSF, brain )Isolation of virus (saliva,CSF, brain )
•SerologySerology
•Viral Ag detection ( infected tissue )Viral Ag detection ( infected tissue )
•Viral DNA detection ( PCR )Viral DNA detection ( PCR )
DIFFERENTIAL DIAGNOSISOther viral encephalitisOther viral encephalitis
Hysteria reaction to animal bite
Landry/Guillan-barre syndrome
Poliomyelitis
Allergic encephalomyelitis ( rabies vaccine )
PREVENTIONPREVENTIONPreexposure ProphylaxisPreexposure Prophylaxis
Postexposure ProphylaxisPostexposure Prophylaxis
HUMAN RABIES BIOLOGICS PRODUCTHUMAN RABIES BIOLOGICS PRODUCT
Rabies immune globulin:Rabies immune globulin:
HUMAN RABIES BIOLOGICS PRODUCTHUMAN RABIES BIOLOGICS PRODUCT
Vaccine:Vaccine: Human diploid cell vaccine (HDCV)Human diploid cell vaccine (HDCV) Purified chick embryo cell vaccine (PCEC)Purified chick embryo cell vaccine (PCEC) Purified Vero cell vaccine (PVRV)Purified Vero cell vaccine (PVRV) Purified duck embryo vaccine (PDEV)Purified duck embryo vaccine (PDEV)
PREEXPOSURE PROPHYLAXISPREEXPOSURE PROPHYLAXIS
Veterinarian, Cave explorers, Veterinarian, Cave explorers, Lab workers, Animal Lab workers, Animal handlershandlersActive immunization (Vaccine) Active immunization (Vaccine)
On days: 0, 7, 21 (28)On days: 0, 7, 21 (28)
Booster doses (Neutralizing Ab <1:5 )Booster doses (Neutralizing Ab <1:5 )
POSTEXPOSURE PROPHYLAXISPOSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatmentWound cleaning & treatment ( Tetanus & Antibiotics )( Tetanus & Antibiotics )
2 – 2 – Passive immunizationPassive immunization
3 –3 – Active immunizationActive immunization
POSTEXPOSURE PROPHYLAXISPOSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatmentWound cleaning & treatment
POSTEXPOSURE PROPHYLAXISPOSTEXPOSURE PROPHYLAXIS2 – 2 – Passive immunizationPassive immunization HRIG 20IU/Kg IM on day 0HRIG 20IU/Kg IM on day 0