Rabies

Rabies is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A rapidly progressive CNS infection caused by an RNA rhabdovirus affecting mammals, including humans
  • Generally considered to be 100% fatal once symptoms develop
  • System(s) affected: nervous
  • Synonym(s): hydrophobia (inability to swallow water)

Epidemiology

Incidence
  • Most cases are in developing countries.
  • Estimated 55,000 deaths worldwide per year
  • Typically only 1 to 3 cases per year in the United States, with 1/3 of those being due to exposure outside of the United States
  • Predominant age: any
  • Predominant sex: male = female

Etiology and Pathophysiology

Lyssavirus, an RNA virus in the family Rhabdoviridae

  • Rabies virus is a neurotropic virus present in saliva of infected animals.
  • Transmission occurs via bites from infected animals or when saliva from an infected animal comes in contact with an open wound or mucous membranes.
  • Bats are most common reservoir in the United States.

Risk Factors

  • Professions or activities with exposure to potentially infected (wild or domestic) animals (e.g., animal handlers, lab workers, veterinarians, cave explorers)
  • Most U.S. cases are associated with bat exposure.
  • Internationally, rabies is widespread in both domestic and feral dogs.
  • Human-to-human transmission has occurred through transplantation of cornea, solid organs, and other tissues.
  • Travel to countries where canine rabies is endemic

General Prevention

  • Preexposure vaccination for high-risk groups (veterinarians, animal handlers, and certain laboratory workers)
  • Consider preexposure vaccination for travelers to areas (such as North Africa) that have increased risk of rabies from domestic animals.
  • Immunization of dogs and cats
  • Contact animal control and avoid approaching or handling wild (or domestic) animals exhibiting strange behaviors.
  • Avoid wild and unknown domestic animals.
  • Seek treatment promptly if bitten, scratched, or in contact with saliva from potentially infected animal.
  • Prevent infection by prompt postexposure treatment.
  • Consider postexposure prophylaxis for individuals in direct contact with bats, unless it is known that an exposure did not occur.
  • Hospital contacts of patients infected with rabies do not require postexposure prophylaxis unless there has been exposure through mucous membranes or an open wound (including a bite) to saliva, CSF, or brain tissue from the infected patient.

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