Rabies is a zoonotic disease caused by RNA viruses. Virus is transmitted in the saliva of rabid mammals via a bite. After entry to the central nervous system, these viruses cause an acute progressive encephalomyelitis. The incubation period usually ranges from 1 to 3 months after exposure, but can range from days to years.

1. Presented by
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 4th year
H.T. No. 15Z11T0006
Anurag Pharmacy College, Kodad
CASE PRESENTATION
ON
RABIES

2. Rabies is a zoonotic disease caused by RNA viruses.
Virus is transmitted in the saliva of rabid mammals via a bite.
After entry to the central nervous system, these viruses cause
an acute progressive encephalomyelitis.
The incubation period usually ranges from 1 to 3 months after
exposure, but can range from days to years.

3. EPIDEMIOLOGY
Over the last 100 years, rabies in the United States has
changed dramatically
Prompt wound care and the administration of rabies immune
globulin (RIG) and vaccine are highly effective in preventing
human rabies
TRANSMISSION
The route of infection is usually, but not necessarily, by a bite.
Various routes of transmission have been documented and
include contamination of mucous membranes.

4. PATHOPHYSIOLOGY
It involves 3 steps
Infection by bite:
The virus directly or indirectly enters the peripheral nervous
system.
It then travels along the nerves towards the central nervous
system.
Virus reaches brain:
Rapid encephalitis develops and symptoms appear.
The spinal cord may inflame producing myelitis.

5. Perivascular infiltration:
Lymphocytes, polymorphonuclear leukocytes, and plasma
cells may leak throughout the entire CNS.
Virus enters salivary glands and other organs of victim.

6. SIGNS AND SYMPTOMS
Early Symptoms
 Fever
Headache
Generalized weakness
Generalized discomfort
Late Symptoms
Insomnia
Anxiety
Confusion
Slight or partial paralysis

7. Excitation
Hallucinations
Agitation
DIAGNOSIS
In animals, rabies is diagnosed using the direct fluorescent
antibody (DFA) test, which looks for the presence of rabies virus
antigens in brain tissue.
Saliva can be tested by virus isolation or reverse transcription
followed by polymerase chain reaction (RT-PCR).
Serum and spinal fluid are tested for antibodies to rabies virus.
Skin biopsy specimens are examined for rabies antigen in the
cutaneous nerves at the base of hair follicles.

8. Case Study
Chief complaint
Unobtainable at the moment
History of present illness
The patent is a 49-year-old male who was walking down the
street and was drinking one liter of Wine roaming exhibiting signs
of confusion. He was called by his neighbor to go back to his
house, as it was hot in the day. The patient refused to go back to
this home and had recurrent falls on his head and sustained
multiple injuries on his limbs and left knee. Along his journey, a
dog came and bit him on his left knee and then ran away.

9. Afterwards, one of the neighbors called the ambulance and the
patient was transferred to the Hospital for further care.
Past Medical History
Hypertension.
Bipolar disorder.
Chronic active alcoholism.

10. Review of systems:
General appearance: Patient was awake and alert and in severe
acute distress
Neck: Mild tenderness in the upper cervical spine/posterior scalp
Eyes: Extraocular muscles intact
Respiratory: no respiratory distress
Cardiovascular: Regular rate and rhythm, no murmurs.
Abdomen: Soft, non tender, non distended.
Neuron: awake alert, and oriented.

11. Family history
Unknown.
Social history
Drinks about one liter of wine every day for the last 20 years and
has multiple admissions for alcohol withdrawal symptoms.

12. Vital Signs
HR: 77 bpm
RR: 13 bpm
BP: 158/90 mmHg
Temp: 101F
Weight: 91kg
Height: 6’6’’

13. DIAGNOSIS
Saliva can be tested by virus isolation or reverse transcription
followed by polymerase chain reaction (RT-PCR)
Serum and spinal fluid are tested for antibodies to rabies virus

14. Lab Investigation:
Content Name Value Normal Value
WBC 148000 H 4,000 to 11,000/µL of blood
Plts 1.24 1.5-4.5 Lakhs
Glucose 76 mg/dL 65-110 mg/dL
Na 129 L 135-145 mmol/L
K 4.0 3.5-5 mmol/L
Cl 75 L 95-105 mmol/L
AST 42 H 10-40 IU/L
ALT 38 7 - 56IU/L
SCr 20.6 H 0.6 to 1.2 mg/dl
BUN 112 H 7 to 20 mg
Albumin 3.6 3.5 to 5.5 g/dL

15. Treatment
Rabies Immune Globulin:
20 IU/kg body weight on day 1.
The administration of RIG provides immediate virus-neutralizing
antibodies until protective antibodies are generated in response to
vaccine
Vaccine
Human diploid cell vaccine (HDCV) or purified chick embryo cell
vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 1, 3, 7
and 14

16. Life style modification
Wash any wounds immediately
One of the most effective ways to decrease the chance for
infection is to wash the wound thoroughly with soap and water
Refer to a doctor
For attention for any trauma due to the animal attack before
considering the need for rabies vaccination
The doctor, possibly in consultation with state or local health
department, will decide on the need of rabies vaccination
Decisions to start vaccination, known as post-exposure
prophylaxis (PEP) are up to the discretion of the physician, but
two organizations have developed recommendations:

17. Advisory Committee on Immunization Practices (ACIP) schedule
for rabies vaccine (2010)
World Health Organization (WHO) pre- and post-exposure
prophylaxis 2010
Vaccinate your cat, dog, or ferret against rabies and keep its
immunization up-todate.
If you find a dead bat, do not touch it.
If you find a bat in the same room as a sleeping person, a child, or
a mentally disabled or intoxicated person, contact your doctor or
community health centre right away as the bat may have bitten
the person. If possible, capture the bat so it can be tested for
rabies.

18. Close all doors and windows in the area. Put on a hat, leather
gloves, a long-sleeved jacket, and pants.
If you are attacked or bitten by any animal, you should get
medical advice about rabies prevention treatment, no matter how
long since you were bitten.
Use a blanket, net, broom or towel to catch the bat (without
touching it and while protecting any exposed area such as the
face). Use tongs to put it in a sealable container. Place the
container in a cool, safe place away from human or pet contact or
put it into the freezer, which will make the bat go into
hibernation. Do not kill the bat. o Call your local community
health center.

19. The bat will be tested for rabies. If it does not have rabies, no
treatment will be necessary.
If bats are in your home, get professional bat control advice.
If your pet has contact with a bat, consult your public health unit.
If you are travelling for a month or more to a developing country
where rabies is often found in different animals, consider being
vaccinated for rabies before you leave. Get advice at a travel
clinic.