Rabies

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Deric Parrish from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

 

Definition/Description

Rabies is derived from the Latin word meaning rage or fury because animals with this disease are often agitated or excited and attack anything in their way.  It is also know as hydrophobia, which means fear of water, because one of the symptoms is an inability to swallow water.  Humans and most warm-blooded animals can get this disease.  Rabies is an infectious, zoonotic disease that destroys brain cells and can lead to death if left untreated before symptoms appear.  It is caused by a virus that lives in the saliva of a host or carrier and can be transmitted by being bitten by the carrier or if the infected saliva enters an open wound or mucous membranes.  Rabies has been reported as being transmitted to people after breathing in air from caves that contained millions of bats and through organ transplants from an infected person.  The most common sources of infections for humans are from wild animals and dogs.

Prevalence

It is estimated that every ten minutes a person dies from being infected by rabies and 10 to 12 million people are immunized with rabies postexposure prophylaxis (RPEP) every year.  Rabies can be found in almost all countries around the world, but Asia and Africa are the most common places in which people die from rabies, usually as a result of a rabid dog bite.  It is estimated that 40,000-70,000 humans die each year as a result of the rabies virus and it is suspected that thousands more deaths go unreported.

Characteristics/Clinical Presentation

The clinical presentation of this disease greatly depends on whether the patient is an animal or a human.  If dealing with an animal with rabies it is best to stay away because the animal will likely attack.  They can be very aggressive even if it has been known to be a very good natured pet.  Once the virus has begun to show symptoms in an animal, it is too late for any kind of intervention.  The best thing to do is to stay far away and notify the proper authorities to have the animal humanely euthanized.

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

Rabies is a zoonotic disease and is caused by a virus that can live in the saliva of most mammals.  The most common cause of transmission to another mammal is by way of a bite from the infected one.  It can also be transmitted through the mucous membranes by way of airborne particles.  Both humans and animals can be infected by this disease which will lead to death if not properly treated before symptoms begin to show.  Once the symptoms begin to present themselves, the prognosis is very poor.  Once the virus enters the body, it travels along the nerves to the CNS producing inflammation.  Symptoms usually develop in about ten days but can take seven months or longer after exposure.  The disease can progress very rapidly and only lasts two to twelve days before death occurs.

Systemic Involvement

Rabies causes inflammation of the CNS once it enters the body and can quickly lead to death if not aggressively treated.  Pain, burning or numbness at the site of infection can be among the first symptoms to present.  Complaints of headache and sleeplessness are also reported.  Muscle spasms in the throat can make it difficult to swallow especially at the sight of water for some infected individuals which is known as hydrophobia.  In later stages of the inflammation, unconsciousness can also occur and lead to death.

Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

• Wound Care Management of the bitten area.
• Maintain ROM to prevent contractures of the patient if in a paralytic or comatosed state.

Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

• Delirium tremens
• Drug overdose or reaction
• Guillain-Barré syndrome
• Poliomyelitis
• Psychiatric disorders; hysteria
• Viral encephalitis
• Bacterial meningitis
• Tetanus
• Strycknine poisoning

Case Reports/ Case Studies

(case studies should be added on new pages using the case study template)

1. Wertheim HF, Nguyen TQ, Nguyen KA, de Jong MD, Taylor WR, Le TV, Nguyen HH, Nguyen HT, Farrar J, Horby P, and Nguyen HD. Furious Rabies after an Atypical Exposure. March 2009. Available online at: 
www.ncbi.nlm.nih.gov/pmc/articles/PMC2656546/

2. Kietdumrongwong P, Hemachudha T. Pneumomediastinum as initial presentation of paralytic rabies: A
case report. October 2005. Available online at:
www.ncbi.nlm.nih.gov/pmc/articles/PMC1282576/pdf/1471-2334-5-92.pdf

Resources

Centers for Disease Control. Available online at:  http://www.cdc.gov/rabies/

Mayo Clinic. Available online at:  http://www.mayoclinic.com/health/rabies/DS00484 

World Health Organization. Available online at:  http://www.who.int/rabies/en/ 

National Center for Biotechnology Information. Available online at:  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002310/

Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

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References

see adding references tutorial.