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BSNIII-B, Group 2

RABIES also known as Lyssa is a rhabdovirus infection of the central nervous system transmitted by infected saliva that enters the human body through a bite or an open wound. if untreated, rabies is a fatal viral encephalitis that causes 30, 000 to 70, 000 deaths worldwide each year rhabdovirus genus Lyssa virus (causative agent) is carried by both wild and domestic animals, including bats, skunks, foxes, raccoons, cats and dogs. After an incubation period that may last from 10 days to many years (normally is 3 to 7 weeks), the virus travels to the brain of the infected animal via the nerves and it multiplies and migrates to the salivary glands. CA: Rhabdovirus genus Lyssa virus - capable of hiding from the immune system MOT: transmitted to human from the saliva of infected animals through bites or contact of infected saliva to mucus membrane, scratches, cuts, or abrasions. POC: 3 to 10 days from the onset of clinical signs and through the course of the disease

PATHOPHYSIOLOGY Risk factors History of an animal bite Infected through abrasion or open wound that is exposed to the infected saliva

Risk factors Rhabdovirus spreads from the local muscle cells and then invades the peripheral nerves travels to the central nervous system manifestations *The incubation period in humans varies according to the severity and location of the bite. For example, bites on the face may result in manifestations in 10 days to a few weeks, whereas bites on the lower extremities may incubate as long as 1 year. Manifestations a. Initial/ Prodromal stage the site of the wound is painful and then exhibits various paresthesias. The infected person is anxious, irritable and depressed. General manifestations of infection such as headache, loss of appetite, and sore throat may appear. The person may also have increased sensitivity to light and sounds and the skin is especially sensitive to changes in temperature. b. Excitement Stage infected person has periods of excitement that alternate with periods of quiet. Attempts to drink cause such painful laryngospasms that the person refuses to drink (hydrophobia). The client experiences convulsions, muscle spasms and periods of apnea. c. Respiratory paralysis/ Terminal phase - unconscious, coma, respiratory distress and death

2 Forms of Rabies a. Furious rabies demonstrate hyperactivity, excited behavior, hydrophobia, and the usual cause of death is cardiopulmonary arrest. b. Paralytic rabies less dramatic and runs longer course compared to furious rabies; muscles become paralyzed starting at the site of bite or scratch; coma slowly develops DIAGNOSTIC EXAMINATION *There is no diagnostic procedure that is conclusive if there are no manifestations. a. viral isolation from the saliva and throat b. examination of blood for fluorescent rabies antibodies through fluorescent antibody testing c. presence of negri bodies oval, round masses in the brain tissue of the dog, conclusively rabies d. characteristic signs and symptoms MANAGEMENT Medical management a. Local treatment of animal bites and scratches by carefully and thoroughly clean and flush wounds with soap and water to remove the saliva and dilute the viral exposure; and, immediately take person with the bite for emergency treatment. b. Control program of rabied dogs in the urban area by immunizing household dogs and cats; immunize people who are exposed to animals. Pharmacological management Post exposure care rabies immune globulin (RIG) is administered for passive immunization. Up to 50% of the globulin is infiltrated around the wound, and the rest is administered intramuscularly. At the same time, an inactivated human diploid cell vaccine (HDCV) is administered intramuscularly, with 1 mL given on the day of exposure and on days 3, 7, 14, and 28 after exposure. RIG and HDCV should never be given in the same syringe or at the same site. If RIG is not available, equine rabies antiserum may be administered after testing the client for horse serum sensitivity. Nursing management a. b. c. d. e. Isolation Provide comfort Provide a restful environment Diet and medication Emotional and spiritual support confirm