Rabies.pptx

Rabies

1. SCENARIO One of my neighbour Brother. Got Symptoms like. Head ache. Fever, sore throat, Nervousness, Confusion, fear of water, Difficuly in drinking, seizures ,Even sight of sounds of water distrubs the patients. Agitation. They went to the clinic and they adviced for tests of CSF analysis ,Skin Blopsy, MRI Brain, Blood tests Can u Guess the topic ...?

2. INTRODUCTION The word rabies originates from the Latin word rabere. Rabere means to rage or rave, and may have roots in a Sanskrit word rabhas, which means to do violence. The Greeks called rabies lyssa or lytta, which means frenzy or madness Rabies is an acute viral disease which causes fatal encephalomyelitis in virtually all the warm blooded animals including man. The virus is found in wild and some domestic animals, and is transmitted to other animals and to humans through their saliva (i.e. Bites, scratches, licks on broken skin and mucous membrane). In urban areas, the disease is mainly transmitted by dogs, being responsible for about 96% of animal bite cases.

3. DEFINITION Rabies is a viral disease that causes inflammation of the brain in humans and other mammals caused by lyssaviruses. Rabies may also refer to: Rabies virus (Rabies lyssavirus )

4. SOURCE OF INFECTION AND INCUBATION PERIOD The source of infection to man is the saliva of rabid animals. In dogs & cats, the virus may be present in the saliva for 3-4 days before the clinical onset & during the course of illness till death. Incubation period It is highly variable in man, commonly 3-8 weeks following exposure. The closer the bite to the brain, the shorter the incubation. Rabies virus travels 1 cm per day.

5. ETIOLOGY Rabies is carried by warm-blooded animals (mammals) and collects in their saliva (spit). You usually get rabies through the bite of an infected animal. Rabies is most commonly found in bats, skunks, raccoons and foxes, but other animals — including your pet dog or cat — can become infected. If a break in your skin comes in contact with the spit of an infected animal, you could get rabies. Rarely, people have gotten rabies from receiving donated organs.

6. PATHOPHYSIOLOGY Viral entry: Initial multiplication in the muscles and connective tissues Retrograde neuronal transmission Reach CNS: Encephalomyelitis Spread through peripheral nerves . Salivary gland. Pancreas, kidney muscles of pharynx
Heart, Retina and
↑ Salivation. Cornea. Hydrophobia .

7. MODE OF TRANSMISSION

8. CLINICAL MANIFESTATIONS Agitation
Seizures.
Difficulty in drinking.
Patients will be able to eat solids Afraid of water – Hydrophobia. Even sight or sound of water disturbs the patient.
But suffer with intense thirst.
Spasms of Pharynx produces choking Death in 1-6 days.
Respiratory arrest / Death/Some may survive.

9. CONT........ Headache, fever, sore throat Nervousness, confusion Pain or tingling at the site of the bite Hallucinations *Seeing things that are not really there Hydrophobia *Fear of water” due to spasms in the throat Paralysis Paralysis *Unable to move parts of the body Coma and death

10. PREVENTION * PRE EXPOSURE PROPHYLAXIS * P OST EXPOSURE PROPHYLAXIS

11. PRE EXPOSURE VACCINATION

12. PRE EXPOSURE PROPHYLAXIS Provided to subjects at risk before occupational or vocational exposure to rabies. Subjects include diagnosticians, laboratory & vaccine workers, veterinarians, cavers, etc. Simplifies post exposure management. Only vaccines used.

13. POST EXPOSURE PROPHYLAXIS Provided to subjects after rabies exposure. Consists of wound care, rabies immune globulin, and vaccine Cleansing Chemical treatment Suturing Anti-Rabies Serum Antibiotics & anti-tetanus measure Observe the animal for 10 days.

14. CONT... Wash lesions well with soap and water (tetanus booster) Infiltrate rabies immune globulin (20 IU/kg) into and around the margin of the bites. Administer vaccine on days 0,3,7,14, and 28. (90)

15. WOUND CLEANING AND TREATMENT

16. TREATMENT POST-EXPOSURE TREATMENT (PET) a. LOCAL WOUND TREATMENT * Wash with soap/detergent and water preferably for . 10 mains . * Apply alcohol, povidone iodine/ any antiseptic * Anti-Tetanus" Avoid suturing wound s Don't apply ointment, cream/ wound dressing

17. CONT... ANTIMICROBIAL * Amoxicillin * Cloxacillin * Cefuroxime *For those instances where there’s no obvious signs of infection( Amoxicillin as prophylaxis)
***Educate the public simple local wound treatment & warn not to use procedures that may further contaminate the wounds

18. VACCINE ADMINISTRATION Intramuscular Schedules * 6 doses schedule
* Reduced multisite intramuscular regimen (2-1-1) Intradermal Schedules . * 2-Site Intradermal schedule(2-2- 2-0-1-1)
* 8-Site intradermal schedule (8-0- 4-0-1-1)

19. VACCINATION Intradermal Schedule PVRV- purified Vero cell rabies vaccine PCECV- Purified chick embryo cell vaccine

20. Intramuscular Schedule

21. MANAGEMENT OF RABIES PATIENT Once symptoms start, treatment should center on comfort care, using sedation & avoidance of intubation & life support measures once diagnosis is certain MEDICATIONS * Diazepam * Midazolam * Haloperidol + Dipenhydramine

22. NURSING MANAGEMENT Supportive care *Pts w/ confirmed rabies should receive adequate sedation & comfort care in an appropriate medical facility. Once rabies diagnosis has been confirmed, invasive procedures must be avoided Provide suitable emotional and physical support Discuss & provide important info. To relatives concerning transmission of disease. & indication for PET of contacts Honest gentle communication concerning prognosis should be provided to relatives of patient

23. CONT... 3. INFECTION CONTROL a. Patient should be admitted in a quiet, draft-free, isolation room b. HLCR workers & relatives in contact w/ patients should wear proper personal protective equipment (gown, gloves, mask, goggles) 4. DISPOSAL OF DEAD BODIES

24. COMPLICATIONS Seizures.
Fasciculations.
Psychosis.
Aphasia.
Autonomic instability.
Paralysis.
Coma.
Death. LATE COMPLICATIONS Cardiac failures Respiratory failures Multiple organ failure