rabies
DESCRIPTION
TRANSCRIPT
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RABIES
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INTRODUCTION
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Rabies or hydrophobia is an
acute, highly fatal viral disease of the central nervous system, caused by Lyssavirus
DEFINITION
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In India, about 15 million people are bitten by animals
In india 25,000–30,000 human deaths from rabies annually.
INCIDENCE
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Lyssavirus is a bullet shaped RNA virus. It belongs to the family rabdoviridae
AGENT FACTORS
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Lassa virus
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3 epidemiological forms
1. Urban rabies
2.Wild life rabies
3.Bat rabies
RESERVOIRS OF INFECTION
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The transfer of infection from wild life to domestic dogs
results in the creation of urban cycle and is responsible for 99% of human cases in India
Urban rabies
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The wild life is perpetuated by the jackal, fox and other
wild life carriers.
Wild life rabies
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In Latin American countries and U.S.A vampire
bat is an important host and vector of rabies
Bat rabies
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Source of infection to man is the saliva of rabid animal. In dogs and cats, the virus may be present in the saliva for 3-4 days before the onset of clinical symptoms and during the course of
illness till death.
SOURCE OF INFECTION
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All warm blooded animals including man are susceptible to rabies. Laboratory staff working with rabies virus, veterinarians, dog handlers, hunters faces higher risk of rabies than general public.
HOST FACTORS
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1.Animal bites
2.Licks
3.Aerosols
4.Person-to-person
MODE OF TRANSMISSION
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In India most of the human rabies cases have resulted
from dog-bites. Transmission to man is particularly through rabid dog bites. As a prerequisite for transmission, the saliva of the dog must contain the virus at the time of bite. It may also occur from other animals beside dog like cat, sheep, goat, monkey, horse.
Animal bites
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Dogs have the habit of licking.
Licks on abraded skin and mucosa can transmit the disease.
Licks
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Aerosol or respiratory transmission is found only in
certain caves harbouring rabies infected bats.
Aerosols
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Man to man transmission, although rare is possible.
A case of a child biting his parent is in record
There is also reports of transmission of rabies by corneal and organ transplants.
Person-to-person
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3-8 weeks The incubation period in man is highly
variable, commonly 3-8 weeks, but may vary from 4 days to many years.
INCUBATION PERIOD
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Bite
Entry of rabies virus in man
Virus replicate in muscle or connective tissue cells at the site of introduction
Virus attaches to nerve endings
PATHOPHYSIOLOGY
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Enters peripheral nerves
Spreads centripetally via peripheral nerves towards CNS
Infects CNS
Virus spreads centrifugally in peripheral nerves to many tissues
Invades skeletal, myocardial muscle, adrenal glands, skin
Contd..
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Duration of illness 2-3 days rarely 5-6 days PRODROMAL SYMPTOMS Headache Malaise Sore throat Slight fever lasting for 3-4 days Pain and tingling at the site of bite
CLINICAL FEATURES
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widespread excitation and stimulation of all parts of nervous
system
1. Intolerance to noise2. Intolerance to bright light3. Intolerance to cold draught of air4. Aerophobia5. Increased reflexes6. Muscle spasms7. Dilatation of pupils 8. Increased perspiration
SPECIFIC SYMPTOMS
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1. Salivation2. Lacrimation3. Mental changes due to fear of death, anger, irritability
and depression4. Symptoms progressively aggravate 5. All attempts at swallowing liquid become unsuccessful6. Mere sight or sound of water provoke spasm of
muscles of deglutination- hydrophobia7. Patient may die abruptly during one of the convulsion
or may pass on to the stage of paralysis or coma
Contd…
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History of bite by a rabid animal Signs and symptoms Detection of rabies antigen Using immunofluroscence of skin biopsy Virus neutralizing antibodies appear in CSF
and serum after 7-10 days of illness Virus isolation from saliva, CSF and other
secretions
DIAGNOSIS
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Nervous tissue vaccines Duck embryo vaccine Cell culture vaccines Human diploid cell vaccine (HDCV) Non- human origin-second generation vaccines
TREATMENT
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Intramuscular schedule
VACCINE ADMINISTRATION
Schedule consist of 6 doses (1 ml each) on days 0, 3,7,14 and 28 and a booster dose on day 90.
Injections are given IM on deltoid and must not be given to buttocks
Dose: one dose, IM dose into deltoid (1ml)
Day 0 3 7 14 28
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2 site ID method
0.5 ml of Purified Vero Cell Vaccine (PVRV) 1 ml of Purified Chick Embryo Cell Vaccine (PCECV) 1 ml of Purified Duck Embryo Vaccine (PDEV) Volume of ID dose is one-fifth of IM dose per site. ie if IM dose is 0.5 ml, ID dose is 0.1 ml.
Dose: 1, ID dose = one fifth of IM dose
Day 0 3 7 28 90
Sites X2 X2 X2 X1 X1
Intradermal schedule
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8 site ID method
Human Diploid Cell Vaccine (HDCV) and Purified Chick Embryo Cell Vaccine (PCECV) On day 0--- 0.1 ml of reconstituted vaccine is given at each of 8 sites. Sites are deltoid, lateral thigh, supra scapular region and lower quadrant of abdomen On day 7--- 0.1 ml of vaccine is given at each of 4 sites over deltoid and thighs. On days 28 and 90--- 0.1 ml of vaccine is given at one site, over deltoid
Dose 0.1ml ID per site
Day 0 7 28 90
Sites X8 X4 X1 X1
8 site ID method
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The patient should be isolated in quiet room protected as far
as possible from external stimuli such as bright light, noise or cold draughts which may precipitate spasms or convulsions
Relieve anxiety and pain by liberal use of sedatives. Ensure hydration and diuresis Intensive therapy in the form of respiratory and cardiac
support may be given Nursing personnel attending rabid patient should be warned
against possible risk of contamination and should wear face masks, gloves, goggles and aprons to protect themselves
Pre- exposure prophylaxis with 2-3 doses of HDC vaccine is reco
GENERAL MANAGEMENT
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POST- EXPOSURE PROPHYLAXIS Local treatment of wound 1. Cleansing 2. Chemical treatment 3. Suturing 4. Anti rabies serum 5. Antibiotics and anti tetanus measure 6. Observe the animal for 10 days
PREVENTION
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1. Horse anti rabies serum 2. Human rabies immunoglobulin
ANTI RABIES SERUM
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laboratory staff working with rabies virus,
veterinarians, animal handlers and wild- life officers
1ml cell culture vaccine, IM on days 0, 7 and 28
PRE-EXPOSURE PROPHYLAXIS
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1 ml, IM doses of human diploid cell vaccine
on days 0, 3 and 7.
POST EXPOSURE PROPHYLAXIS
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ASSESSMENT
ask for a history of bite by an animal - assess whether he has undergone immediate
prophylactic measures - assess for characteristics like photophobia,
hydrophobia etc - check for the presence of antigen
NURSING MANAGEMENT
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1. Hyperthermia related to infectious
process as evidenced by elevated body temperature more than 100 degree farenheit
2. Acute pain related to tissue injury at the site of bite as evidenced by pain scale score more than 7
3. Fatigue related to bacterial invasion of central nervous system as evidenced by inability to perform ADLs
4. Risk for injury related to confusion
NURSING DIAGNOSIS
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Malaria
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Malaria is a protozoal disease caused by
infection with parasites of the genus Plasmodium and transmitted to man by infected female Anopheles mosquito
DEFINITION
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Female anophelous mosquito
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300-500 million clinical cases each year.
INCIDENCE
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1. P.vivax,2. P. falciparum3. P. malariae,4. P. ovale.
AGENT FACTORS
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Age- malaria affects all ages Gender- males are more frequently affected
because of the outdoor life they lead Pregnancy-pregnancy increases risk of malaria in
women. Malaria during pregnancy may cause intrauterine death of foetus, premature labour or abortion
Socio-economic development- poor socioeconomic status contributes to malaria
Occupation - It is predominantly a rural disease and is related to
HOST FACTORS
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Season – it is a seasonal disease and has
maximum prevalence from July to November. Temperature – malarial parasite develops at the
temperature of 20-30 degree celcius Humidity – a relative humidity of 60% is
considered necessary for mosquitoes to live Rainfall – rainfall provides opportunities for
breeding of mosquitoes and increases epidemics Man-made malaria – burrow pits, garden pools,
irrigation channels, engineering projects led to breeding of mosquitoes.
ENVIRONMENTAL FACTORS
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VECTOR TRANSMISSION DIRECT TRANSMISSION CONGENITAL MALARIA
MODE OF TRANSMISSION
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Usually less than 10 days falciparum malaria it is 9-14days quarten malaria it is 18-40 days vivax it is 8-17 ovale it is 16-18
INCUBATION PERIOD
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COLD STAGE HOT STAGE SWEATING STAGE
CLINICAL FEATURES
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Demonstration of parasite in blood Dipstick (antigen capture) assay for detection
of plasmodium falciparum
DIAGNOSIS
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Presumptive Treatment Radical Treatment Treatment of resistant infection Severe and Complicated Malaria
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NURSING DIAGNOSIS 1. Acute pain related to inflammatory
process as evidenced by pain scale score above 7
2. Hyperthermia related to infectious process as evidenced by elevated body temperature
3. Fatigue related to bacterial invasion as evidenced by inability to perform ADLs
NURSING MANAGEMENT
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EVIDENCE BASED PRACTICE
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SUMMARY
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CONCLUSION
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BIBLIOGRAPHY
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Thank you