Lecture for the students & graduates of Doctor of Pharmacy, Bachelor in Medicine & Surgery, Doctor of Veterinary medicine, Microbiology & Pathology

1. RABIES
Dr.Muhammad Umair
Pharm.D, M.Phil. Clinical Pharmacy
Lecturer
Lahore Pharmacy College Of
Lahore Medical & Dental College (Pakistan)

2. Rabies
• Zoonotic viral infectious diseases; almost invariably fatal
• Virus attacks on the nerves system and later excreted in saliva
• A person can become victim in following ways;
• Bites of diseasedanimals
• Non-bites exposure
• Human to Human Transmission

3. Virology
• Rabies virus belongs to Lyssavirus genus of Rhabdoviridae
family
• Virus is enveloped and has a single stranded RNA genome
• All rahbdoviruses have two major structural components;
• Helical ribonucleoprotein core (RNP)
• Surrounding envelops

5. Epidemiology
• Asia
• Most of the developing countries in Asia are the victims
• Over 30,000 people die every year due to rabies in Asia
• 15% are likely to be the children under 15 years
• India, Srilanka, Bangladesh, Pakistan, Nepal are high risk areas
• Africa
• More than 24,000 deaths per year in Africa
• Majority of them are from poor rural communities or children
• Angola, Namibia, Mozambique, Zimbabwe are high risk areas

6. • Europe and united states
• On verge of disappearance from many
countries
• Policy of animalvaccination

7. Rabies free zones

8. Pathogenesis
• Transmission
• Bite of a rabid animal (Dogs, Bats, Racoons, Foxes,Skunks)
• Contamination of scratch wounds by virus infected saliva
• Incubation
• Replication in the striated or connective tissue at the site of
inoculation
• Enters the peripheral nerves through the neuromuscular junction

10. Clinical manifestation
• Initial symptoms (Prodrome)
• nonspecific
• Neuropathic pain at site of bite pruritus tingling
• Fever, anxiety, and malaise
• The initial symptoms of rabies are often vague and it can be easy to mistake them for other,
less serious, types of infection. Theyinclude:
• Fever
• Headache
• Feeling generally unwell
• Feeling scared or anxious

11. • After 2–10 days neurological signs appear
• Encephalitic and Paralytic forms
• Encephalitic manifestations
• May appear in episodes
• cerebral dysfunction and autonomic dysfunction
• Agitation, confusion, hydrophobia,aerophobia,
• hyperventilation, hyper-salivation, priapism, and convulsions
• Paralytic manifestations
• Peripheral nerves accompanied byfever
• Within 2–12 days, coma and cardiorespiratory failure starts

12. • Advanced symptoms
• After 10-14 days of prodromal phase, more severe symptoms start todevelop.
• Aggressive behaviour, hallucinations, agitation and producing lots of saliva
• Paralysis, and eventually death

14. Clinical forms of rabies
• Encephalitic = furious
• ~ 80%
• Paralytic = dumb
• ~ 20%

15. Encephalitic rabies
• Prodromal symptoms
• Paresthesia, Pain, Pruritus at site of bite
• Episodes of generalized arousal or hyper-excitability separated by lucid
periods
• Autonomic dysfunction
• Hydrophobia

16. Paralytic rabies
• Paresthesia, Pain, Pruritus at site of bite
• Early flaccid muscle weakness
• Often begins in bitten extremity
• Progresses to produce Quadriparesis
• Bilateral facial weakness
• Sensory examination is usually normal
• Sphincter involvement
• Fatal outcome
• Often misdiagnosed as Guillain - Barré syndrome

17. Diagnosis
• Tests are also performed on the samples of saliva, serum, and skin biopsies
of hair follicles at the nape of the neck

18. Human rabies prevention
• Pre-exposure prophylaxis
• Post-exposure management

19. Post-exposure immunization individuals
not previously vaccinated
• Wound site(s)
• Immediate thorough cleansing of all wounds with soap and water.
• Tetanus prophylaxis; antibiotics
• Human Rabies Immune Globulin (RIG)
• 20 IU/kg body weight
• As much of the RIG as possible should be infiltrated in wound(s)
• The remainder should be given IM at a site distant from vaccine
• Rabies Vaccine
• IM (1 mL) in the deltoid area on days 0, 3, 7, 14, and 28

20. Pre-exposure prophylaxis
• Populations at increased risk of exposure torabies
• Rabies research laboratory workers
• Veterinarians, staff, veterinary students
• Animal control and wildlife workers
• Bat handlers
• Spelunkers
• Travellers to certain rabies-endemic areas

21. • Rabies Vaccine
• 3 doses of rabies vaccine (days 0, 7, and 21 or28)
• May check rabies antibody titer periodically (>0.5 IU/mL)
• After a rabies exposure
• 2 doses of IM rabies vaccine (days 0 and3)
• No HRIG