Rabies
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Transcript of Rabies
-DR.VEKARIYA KUSHAL
CLINICAL MANIFESTATION PRODROMAL FEATURESENCEPHALITIC RABIESPARALYTIC RABIES
CLINICAL MANIFESTATION
• EMPHASIS MUST BE ON POST EXPOSURE PROPHYLAXIS INITIATED BEFORE ANY SYMPTOMS OR SIGNS DEVELOP
• USUALLY BE SUSPECTED ON THE BASIS OF THE CLINICAL PRESENTATION. • THE DISEASE USUALLY PRESENTS AS AN ATYPICAL ENCEPHALITIS WITH RELATIVE
PRESERVATION OF CONSCIOUSNESS.• IT DIFFICULT TO RECOGNIZE IN THE LATE STAGE .(EX :- COMA )• A MINORITY OF PATIENTS PRESENT WITH ACUTE FLACCID PARALYSIS. • THERE ARE PRODROMAL, ACUTE NEUROLOGIC, AND COMATOSE PHASES THAT USUALLY
PROGRESS TO DEATH DESPITE AGGRESSIVE THERAPY
PRODROMAL FEATURES
• THE WOUND HAS USUALLY HEALED BY THIS POINT, AND SYMPTOMS PROBABLY REFLECT INFECTION WITH ASSOCIATED INFLAMMATORY CHANGES IN LOCAL DORSAL ROOT OR CRANIAL SENSORY GANGLIA.
Earliest specific neurologic symptoms
of rabies
paresthesia, pain, or pruritus near the site of the exposure, which
occurs in 50–80% of patients and strongly suggests rabies.
The earliest clinical features of rabies
begin with nonspecific prodromal
manifestations
fever, malaise, headache, nausea, and vomiting. Anxiety or agitation
ENCEPHALITIC RABIES
• IN ENCEPHALITIC RABIES, EPISODES OF HYPER EXCITABILITY ARE TYPICALLY FOLLOWED BY PERIODS OF COMPLETE LUCIDITY THAT BECOME SHORTER AS THE DISEASE PROGRESSES.
Encephalitic rabies Two acute neurologic forms of rabies are seen in humans:
1Encephalitic (furious)
in 80%
2paralytic in 20%.
Manifestations of encephalitic rabies may be
seen in other viral encephalitides
include fever,
confusion, hallucinatio
ns, combativen
ess, and seizures.
Autonomic dysfunction is
common
hypersalivationgooseflesh, cardiac arrhythmia,
and priapism.
• THESE SYMPTOMS ARE PROBABLY DUE TO DYSFUNCTION OF INFECTED BRAINSTEM NEURONS THAT NORMALLY INHIBIT INSPIRATORY NEURONS NEAR THE NUCLEUS AMBIGUOUS (GROUP OF LARGE MOTOR NEURON) RESULTING IN EXAGGERATED DEFENSE REFLEXES THAT PROTECT THE RESPIRATORY TRACT.
In rabies early brainstem involvement
hydrophobia
aerophobia
involuntary, painful contraction of the diaphragm and accessory
respiratory, laryngeal, and pharyngeal muscles in response to
swallowing liquids.
The combination of hyper salivation and
pharyngeal dysfunctionresponsi
ble “foaming at the mouth”.
BRAINSTEM DYSFUNCTION PROGRESSES RAPIDLY, AND COMA FOLLOWED WITHIN DAYS BY DEATH IS THE RULE UNLESS THE COURSE IS PROLONGED BY SUPPORTIVE MEASURES.
cardiac and/or respiratory failure, disturbances of water balance (syndrome of inappropriate antidiuretic hormone secretion or diabetes insipidus), noncardiogenic pulmonary edema, and gastrointestinal hemorrhage.
late complications
Cardiac arrhythmias may be due to dysfunction affecting vital centers in the brainstem or to myocarditis. Multiple-organ failure is common in
patients treated aggressively in critical care units.
PARALYTIC RABIES
• PATIENTS WITH PARALYTIC RABIES GENERALLY SURVIVE A FEW DAYS LONGER THAN THOSE WITH ENCEPHALITIC RABIES, BUT MULTIPLE-ORGAN FAILURE NEVERTHELESS ENSUES.
20%.
which muscle weakness
predominatescardinal features of encephalitic rabies
(hyperexcitability, hydrophobia, and aerophobia) are lacking.
There is early and prominent flaccid muscle weakness, often beginning in the bitten extremity and spreading to
produce quadriparesis and facial weakness.
Sphincter involvement is common
sensory involvement is usually mild, and these cases are commonly misdiagnosed as Guillain-Barré syndrome.
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