Rabies

rabiesRabies (rabies; synonym: rabies, hydrophobia, lyssa) is an infectious disease with primary Central nervous system, accompanied by spasms, cramps pharyngeal and respiratory muscles, ending always lethal.
Etiology. The causative agent of rabies is a virusthat are resistant to low temperatures, but quickly lost on drying and even medium temperature (at temperature 60 degrees the virus will die instantly). The rabies virus is localized mainly in the brain and spinal cord. Babes, and then Negri described the specific inclusion in the nervous cells of the brain of patients with rabies, which were named calves Babes - Negri.
Epidemiology. A person infected with rabies usually by the bite of animals (mostly dogs and wolves, cats, foxes and other). Infection is possible and in contact with infected saliva on broken skin or mucous membranes. The main keepers of the virus in nature are wolves, jackals and dogs. A person can be infected from cows, horses and even birds. Only rarely observed human infection from a person and through contaminated with the virus things. Practically it is important that the rabies virus can persist in the decomposing corpses for many weeks, especially in winter time. Milk, urine, bile rabies virus does not contain. The rate of occurrence of disease depends on the location of the bite, the depth of the wound. The most dangerous bites to the head, face, hands.
In dogs rabies is more often shown after the latent period (14-16 days) strong excitation. The dog is eating or licking the bite, she dilate pupils, concern is mounting. The dog can run away from home, bite people and animals without barking, to swallow different inedible items. Appetite may be saved. The animal, there is a strong salivation, vomiting. Rabies is not mandatory symptom of the disease. During stimulation lasts 1-3 days, and then comes the stage of paralysis and death. The development of paralysis begins with the hind legs. In a quiet form of rabies excitation of the dog does not happen, it usually does not attack people. In part of the cases in dogs is the mixed form of rabies with moderate excitation and paralysis. Cats and wild predators of the disease runs with a predominance of excitation. In cattle there paralytic form.
Pathology and pathogenesis. Promotion of rabies virus from the site of the bite occurs mainly through the nerve trunks with perineurally liquid. The virus invades the brain and spinal cord, causes there inflammation. Characterized by convulsions breathing and swallowing muscles, caused by defeat of the nuclei of wandering and language-glotocnogo nerves. Irritation of the sympathetic nerve leads to increased secretion of saliva.
From the brain centrifugal virus in nerve trunks gets into the salivary glands, infecting them. Autopsy of people who have died from rabies, are brain swelling, hyperemia, petechial hemorrhages mainly in the field amonova horns, found bullock Babes - Negri.
The immune system. Pasteur (rabies) vaccinations create active immunity, which develops within 2 weeks after vaccination and stored for about a year.
The clinical picture. The incubation period for rabies ranges from 8 days to 1 year more - about 40 days. Its duration depends on the site of the bite, the depth of the wound, age of the victim, the application of the vaccine. The shorter the incubation period when bitten in the face, and head. If the bite of a rabid wolf in the head, the incubation period is very short - 8-14 days.
Human disease begins with precursors: first, there are local phenomena in the area of the former bite. The scar turns red, there is a swelling of the skin, a sense of stinging and itching, body temperature rises to 37,5-38 degrees. Appear irritability, inexplicable fear, anxiety, headache, insomnia, depressed mood, loss of appetite; the patient is restless. At the same time difficult swallowing, you may experience respiratory distress. The total duration of this period of 1 to 3 days. Then comes the period expressed excitement, you receive rabies (hydrophobicity). When you try to drink occurs painful spasm, sick with horror refuses to drink only water or even thought about it cause a seizure attack the muscles of the pharynx. The slightest irritation of the skin, the touch of cold items, the movement of air cause seizures and convulsions muscles of the pharynx, spasm of breath (aerophobia). Pupils dilate, face distorted by convulsions, becomes bluish.
During stimulation is accompanied by profuse salivation. The saliva of the patient is unable to swallow, splashes her around. Heart rate accelerated. This period lasts 1-3 days. In late possible hallucinations, delirium, incoherent speech, General concern. At times appear to rage, during which the patient may bite others. Often the patients die at this time from paralysis of the heart or breathing. In some cases, people can live to the point of paralysis. Sometimes it may be atypical course of the disease. Such features as the hydrophobicity or aerophobia, no, the disease occurs in the form of paralytic or meningoencephalitides form. Rage against the background of chronic alcoholism can proceed with pronounced hallucinations.
The diagnosis. When you deploy a typical clinical picture of the disease and in history is an indication, animal bite, the diagnosis is not difficult. Now for the rapid detection of antigen in the drug successfully applied research of the method of fluorescent antibodies. Great diagnostic importance detection Taurus Babes - Negri histological examination of the brain dead animals and dead people. But their absence does not exclude diseases rabies. If the ox Babes - Negri could not find at the research method of fluorescent antibody negative results are obtained, it is necessary to resort to a biological sample, i.e. intra-cerebral or intramuscular infection experimental animals.
Forecast hopeless. The disease results in death on 5-7th, occasionally on the 10-12-th day of illness. Sometimes death occurs within days.


Treatment of symptomatic. Perspective the application of rabies immunoglobulin ( in high doses already in the first hours of the disease. The patient is placed in a private room, create a full peace, bed protect nets avoid irritating noise, light, loud conversations. To feed the patient should be cautious, as he comes causes of swallowing muscles. Appoint a means of reducing agitation: morphine or omnopon 2-3 times a day in combination with bromine, by chloral hydrate in enemas (2 g in 50 ml of water). Drip enema with amytal sodium (30-40 ml of 2% solution 2-3 times a day).
Prevention is to control of rabies in animals. Because in the vast majority of cases of rabies in humans is developed as a result of the attack mad dogs, mandatory registration for them, given preventive inoculations, the destruction of stray and homeless dogs.
All cases of rabies in animals kill and take for research in veterinary laboratory. If bite human animal outwardly cool, you need to isolate him and watch him 14 days.
If animals infected by rabies, bitten healthy animal, last conducted rabies vaccinations, putting to the veterinary clinic. In the hearth is disinfection 2-3% a solution of caustic soda, formalin, Lysol. Litter, straw burned. Clothing, covered in saliva, boil or iron a hot iron. The consumption of meat and milk of patients with rabies in animals is prohibited.
Specific prevention. When applying for the aid of people affected by the bite of an unknown animal or animals suspected to be infected with rabies, primarily produce local treatment of wounds. If the wound is bleeding, should not be prevented bleeding, to hurry up with stitches. The wound is washed with a strong jet of liquid soap (20% liquid soap), cauterised alcoholic iodine solution, fuming nitric acid; then it is advisable to cover the wound rabies gamma globulin. The victim the wound without losing a single day, sent for vaccination at the Pasteur station or item, either on the SES, as rabies vaccination made only in these institutions. The delay is most likely attributable to the inefficiency of vaccination. The question on reasons for immunization, their duration, should be combined with other methods of treatment is decided individually by medical specialists. Immunized last from 15 to 45 days. For rabies vaccinations use a variety of vaccines - Pasteur, Fermi, Phillips (see Rabies vaccine). During vaccination patient must follow the instructions of health workers (not to drink alcoholic beverages, to avoid fatigue, colds). In severe bites to the face, head, hands and fingers vaccination against rabies is combined with the use of rabies immunoglobulin (0.25-0.5 ml per 1 kg of weight). Application of rabies vaccination has sharply reduced the incidence of rabies. When applying vaccination may experience local reactions (redness, soreness, infiltration), occasionally General: shock; very rarely observed meningoencephalitis, mality.