DAVE JAY S.

MANRIQUEZ
RN.

RABIES

RABIES

CONTENTS:

What is rabies? (DEFINITION & ETIOLOGY)

Is an acute infectious disease of warm-blooded animals and

humans characterized by an involvement of the nervous system
resulting in death.
It is caused by the RABIES VIRUS, a rhabdovirus of the genus
lyssavirus.

Rabies is a serious disease. Each year, it kills more than

50,000 people and millions of animals around the world.
Rabies is a big problem in Asia, Africa, and Central and South
America. In the United States, rabies has been reported in
every state except Hawaii. Any mammal can get rabies.
Raccoons, skunks, foxes, bats, dogs, and cats can get rabies.
Cattle and humans can also get rabies. Only mammals can get
rabies. Animals that are not mammals -- such as birds,
snakes, and fish -- do not get rabies. Rabies is caused by a
virus. An animal gets rabies from saliva, usually from a bite of
an animal that has the disease.

The Rabies Virus

RV a neurotropic filterable virus present in the

saliva of rabid animals. It has a preferrence for
nerve tissues.

Rod-shaped rabies
viruses colored for
effect

Virus minute organism not visible with ordinary light

microscopy. It is parasitic in that it is entirely dependent on
nutrients inside cells for its metabolic and reproductive needs.
Can only be seen by use of eclectron microscopy. Consists of
DNA or RNA covered with a protein covering called capsid.
Neurotropic viruses that reproduce in nerve tissue
Filterable virus virus causing infectious disease, the
essential elements of which are so tiny that they retain
infectivity after passing through a filter of the Berkefeld
type.
Berkefeld filter a filter of diatomaceous earth designed to
allow virus-size particles to pass through
Diatomaceous earth substance composed of diatoms, a group
of unicellular microscopic algae that possess a siiceous or
calcium-containing cell wall.
Parts of the rabies virus

A rhabdovirus of the genus lyssavirus.

RHABDOVIRUS: any group of rod-shaped RNA viruses with 1 important
member, rabies virus, pathogenic to man. The virus has a predilection for
tissue of mucus-secreting glands and the Central Nervous System. All
warm-blooded animals are susceptible to infection with these viruses.

RHABDO: from Greek rhabdos, "rod"

LYSSA: Greek frenzy, rage, fury, canine madness

This is a photograph of the

virus under electron
microscope

Mononegavirales

order

Rhabdoviridae
vesiculovirus

genus

novirhabdovirus

ephemerovirus

cytorhabdovirus

family

nucleorhabdovirus
lyssavirus
species

Australian Bat
lyssavirus

European Bat
lyssavirus 1

European Bat
lyssavirus 2

Duvenhage virus

Mokola Bat virus

Lagos Bat virus

Rabies virus

How do you get rabies?

(MODE & MEDIA OF TRANSMISSION, IMMUNITY)

All warm-blooded mammals are susceptible. Natural immunity in man is

unknown.
You get rabies through the saliva of an infected animal by an exposure to
an open break in the skin such as bites, open wound or scratch and
inhalation of infectious aerosols such as from bats.
In some cases, it is transmitted through organ transplants (corneal
transplant), from an infected person.
The virus gets transmitted through saliva, tears, semen, some liquor
(amniotic fluid, CST) but not blood, urine or stool.
You get rabies from the saliva of a rabid animal, usually
from a bite. The rabies virus is spread through saliva.
You cannot get rabies by petting an animal. You may get
rabies from a scratch if the animal, such as a cat, was
licking its paw before it scratched you. (Remember that
the rabies virus is found in the saliva of an animal).

How do you know if an animal has rabies?

Animals with rabies may act differently from
healthy animals.
Some signs of rabies in animals are:

changes in an animals behavior

general sickness (fever, restlessness)
problems swallowing
increased drooling
aggression (biting at inanimate objects, aimless running)

Wild animals may move slowly or may act as if they are tame. Some wild animals
(foxes, raccoons, skunks) that normally avoid porcupines, may even try to bite
these prickly rodents.
A pet that is usually friendly may snap at you or may try to bite.

How do you know if one has

(DIAGNOSIS)
rabies?
There is yet no way of immediately knowing who had acquired

rabies virus. No tests are available to diagnose rabies in humans

before the onset of clinical disease.
The most reliable test for rabies in patients who have clinical signs
of the disease is a DIRECT IMMUNOFLUORESCENT STUDY of a
full thickness biopsy of the skin taken from the back of the neck
above the hair line.
The RAPID FLUORESCENT FOCUS INHIBITION TEST
is used to measure rabies-neutralizing antibodies in
serum. This test has the advantage of providing results
within 24 hours. Other tests of antibodies may take as
long as 14
days.

EPIDEMIOLOGY
RABIES INCIDENCE:
WORLDWIDE:35,
000- 50, 000 cases/
year
(WHO)

 parts of Africa and Asian continents and many parts

of South America are endemic for rabies
UK and most of Western Europe are rabies free due
to success of coordinated wildlife oral vaccination
programs

annual # of deaths caused by rabies worldwide:

50,000-60,000

EPIDEMIOLOGY

PHILIPPINES: 350-450 cases/ year

5-7 per million population
DOG BITE INCIDENCE: 140, 000- 560, 000/ year
200-800 per 100, 000 population/ year

AGE MOST AFFECTED: 5-14 year age group

(53% of cases)
BITING ANIMALS: (SLH STUDY 1982- 2002)

DOGS:
98%
PET:
88%

STRAY: 10%
CATS:
2%

 Based on the report from NCDPC (2004), the six

regions with the most number of rabies cases
are Western Visayas, Central Luzon, Bicol,
Central Visayas, Ilocos and Cagayan Valley
Data shows that 53.7 percent of animal bite
patients are children
Dogs remain the principal animal source of rabies

The trend for animal bite cases has increased from 1992 to 2001 but decreased
in the year 2002-2004. The increasing number of patients who are consulting
the health centers for animal bite cases is due to the increasing level of
awareness on rabies. On the other hand, the human rabies cases have been
decreasing from 1995 to 2004. This is due to early provision of post exposure
vaccination to dog bite victims.
In 2004, there were
95,568 animal bite
victims reported with 88
percent of them bitten
by dogs. Of this animal
bite victims, 55,582 or 58
percent had postexposure
vaccination and the other
40,000 or so had no
vaccine protection at all.
During the same
year, 228 (0.2 percent of
the total animal bite
cases) were confirmed
cases based on the
appearance of the
unequivocal signs and
symptoms of rabies which
include death for
most.

Distribution of
Animal Bite
Cases of Cebu
Province
(Jan-June 2006)

How does rabies affect us?

(PATHOPHYSIOLOGY & SIGNS N SYMPTOMS)

What does the virus do?

The targets of the rabies virus are nerve

cells. Nerve cells are one part of the bodys
nervous system. Once inside the body, the
rabies virus infects the nerve cells and
travels along the peripheral nerves (the
nerves that run throughout the body). Its
main target is the central nervous system,
which is made up of the brain and spinal
cord.

How does the virus travel?

When the virus travels from the peripheral

nerves (infected periphery) to the brain, it
is called CENTRIPETAL SPREAD.
The viral travel and spread from the center
(brain) to the periphery is called
CENTRIFUGAL SPREAD.

PATHOLOGY CHART 1: Rabies infection

PATHOLOGY CHART 2: Rabies Infection

STAGES OF RABIES
INFECTION
Rabies virus

Entry into the body

INCUBATI0N PERIOD

(20 90 days)

INVASION
(0 10 days)

EXCITEMENT
(2 7 days)

PARALYTIC

COMA
(5 14 days)

DEATH

RABIES CLASSIFICATION
ANIMAL RABIES
There are two common types of rabies. One type is "furious" rabies. Animals with this type are hostile, may
bite at objects, and have an increase in saliva. In the movies and in books, rabid animals foam at the mouth.
In real life, rabid animals look like they have foam in their mouth because they have more saliva.
The second and more common form is known as paralytic or "dumb" rabies. The dog pictured below has this
type. An animal with "dumb" rabies is timid and shy. It often rejects food and has paralysis of the lower
jaw and muscles.
Another two types of rabies. One type is urban rabies. The type of rabies in domestic dogs and cats.

The other type is called sylvatic rabies. These type came from wild animals such as bats, weasels, skunks
and moles & voles.
HUMAN RABIES
Humans also have a furious type, the classic foaming of the mouth, aggression, apprehension &

hydrophobia, and the dumb type, progressive paralysis of the body until they couldnt breathe anymore.

DIFFERENT STAGES OF RABIES

INFECTION
C
A
T
S

D
O
G
S

B
A
T
S

VIRUS IN SALIVA

VIRUS IN SALIVA

INHALED AEROSOLS

INVASION PHASE

INVASION PHASE

PARAL
YSIS
EXCITEMENT

PARAL
YSIS

DEATH

DEATH

MANAGEMENT
PREVENTION

Responsible pet ownership

a) pet immunization, esp. cats, usually starting at 3 months of age and every year thereafter
b) dont allow pets to roam around the streets
c) take care of your pets, keep them in good health bathe, feed with clean adequate food and
provide clean sleeping quarters

Thoroughly clean ALL BITES AND SCRATCHES made by any animal with strong
medicinal soap or solution.
Responsible awareness. Report immediately rabid or suggestive of rabies
domestic or wild animals to proper authorities (local government clinic,
veterinarians or community officials).
Pre-exposure to high risk individuals. Veterinarians, hunters, people in contact
with animals (zoo), butchers, lab-staff in contact with rabies, forest
rangers/caretakers.
DOH Standard Protocol

If dog is apparently healthy, observe the dog for 14 days. If it dies or show signs suggestive or rabies,
consult a physician.
If the dog shows signs suggestive of rabies, kill the dog immediately and bring head for lab examination.
Submit for immunization while waiting for results.
If the dog is not available for observation (killed, died or stray), submit for
immunization.

A cats brain for examination

*see DOH- Revised Guidelines on Management of Animal Bite Patients- 2007 for more complete guide

MANAGEMENT
MEDICAL INTERVENTIONS

Local wound treatment. Immediately wash wound with soap and water. Treat with
antiseptic solutions such as iodine, alcohol and other disinfectants.
Antibiotics and anti-tetanus as prescribed by physician.
Rabies Specific Treatment. Post-exposure treatment is given to persons who are
exposed to the rabies virus. It consists of active immunization (vaccination) and
passive immunization (immune globulin administration).

ACTIVE IMMUNIZATION aims to induce the body to develop antibodies and T-cells against
rabies up to 3 years. It induces an active immune response in 7-10 days after vaccination,
which may persist for one year or more provided primary immunization is completed
MEDICAL AGENT: Human Diploid Cell rabies Vaccine (HDCV)
PASSIVE IMMUNIZATION aims to provide IMMEDIATE PROTECTION against rabies which
should be administered within the first 7 days of active immunization. The effect of the
immune globulin is only short term. Rabies antibodies are introduced before it is
physiologically possible for the patient to begin producing his own antibodies after
vaccination. Some of the RIG is infiltrated around the site and the rest is given
intramuscularly.
MEDICAL AGENT: Rabies Immune Globulin (RIG)

MANAGEMENT
NURSING INTERVENTIONS

HIGH RISK FOR INFECTION TRANSMISSION

provide patient isolation

handwashing. Wash hands before and after each patient contact and following procedures that offer
contamination risk while caring for an individual patient. Handwashing technique is important in reducing
transient flora on outer epidermal layers of skin.
Wear gloves when handling fluids and other potential contaminated articles. Dispose of every after patient
care. Gloves provide effective barrier protection. Contaminated gloves becomes a potential vehicle for the
transfer of organisms.
Practice isolation techniques. To prevent self-contamination and spread of disease.

assess patients and familys level of knowledge on the disease including concepts, beliefs and known treatment.
Provide pertinent data about the disease:
organism and route of transmission
treatment goals and process
community resources if necessary
allow opportunities for questions and discussions

If patient is still well oriented, Inform the relation of fever to the disease process. The presence of virus in
the body
Monitor temperature at regular intervals
Provide a well ventilated environment free from drafts and wind.

Assess level of dehydration of patient.

Maintain other routes of fluid introduction as prescribed by the physician e.g. parenteral routes
Moisten parched mouth with cotton or gauze dipped in water but not dripping.

KNOWLEDGE DEFICIT (about the disease, cause of infection and preventive measures)

ALTERED BODY TEMPERATURE: FEVER RELATED TO THE PRESENCE OF INFECTION.

Since fever is continuous, provide other modes to reduce discomfort.

DEHYDRATION related to refusal to take in fluids secondary to throat spasms and fear of
spasmodic attacks.

OBJECTIVES:
To provide new policy guidelines and
procedure to ensure an effective and
efficient management for eventual reduction
if not elimination of human rabies
To increase voluntary pre-exposure
coverage among high risk group (animal
handlers, field workers, health staff working
in rabies unit, rabies diagnostic lab staff,
children 15 yo living in endemic areas.

SPECIFIC GUIDELINES AND

PROCEDURES:

Management of
Potential Rabies
Exposure

3 CATEGORIES OF
EXPOSURE
CATEGORY I
Feeding/ touching an animal
Licking of intact skin (w/ reliable history
and thorough physical examination)
Exposure to patient with signs and
symptoms of rabies by sharing of eating or
drinking utensils *
Casual contact to patient with signs and
symptoms of rabies*

MANAGEMENT:
1.Wash exposed skin
immediately w/ soap and
water

2. No vaccine or RIG needed

*Pre-exposure vaccination may be considered

CATEGORY II
Nibbling/ nipping of uncovered skin with
bruising
Minor scratches/ abrasions without
bleeding**
Licks on broken skin
**includes wounds that are induced to bleed

MANAGEMENT:
Complete vaccination regimen until day 28/30 if:
Animal is rabid, killed, died OR unavailable for 14- day
observation or examination OR
Animal under observation died within 14 days and was
IMMUNOFLOURESCENT ANTIBODY TEST (IFAT)positive OR no IFAT testing was done OR had signs of
rabies

Complete vaccination regimen until day 7 if:

Animal is alive AND remains healthy after 14- day
observation period
Animal under observation died within 14 days but had no
signs of rabies and as IFAT- negative.

CATEGORY III
Transdermal bites or scratches ( to include puncture
wounds, lacerations, avulsions)
Contamination of mucous membrane with saliva (i.e.
licks)
Exposure to a rabies patient through bites, contamination
of mucous membranes or open skin lesions with body
fluids (except blood/feces) through splattering, mouth-tomouth resuscitation, licks of the eyes, lips, vulva, sexual
activity, exchanging kisses on the mouth or other direct
mucous membrane contact with saliva.
Handling of infected carcass or ingestion of raw infected
meat
All Category II exposures on head and neck area
*Does not include sharing of food/ drink/ utensils and
casual contact with rabid patient

MANAGEMENT
Complete vaccination regimen until day 28/ 30 if:
Animal is rabid, killed, died OR unavailable for 14 day
observation or examination OR
Animal under observation died within 14 days and was
IMMUNOFLOURESCENT ANTIBODY TEST (IFAT)positive OR no IFAT testing was done OR had signs of
rabies

Complete vaccination regimen until day 7 if:

Animal is alive AND remains healthy after 14-day
observation period.
Animal under observation died within 14 days but had
no signs of rabies and was IFAT- negative

IMMUNIZATION
ACTIVE IMMUNIZATION
- induce antibody and T-cell production in order
to neutralize the rabies virus in the body. It
induces an active immune response in 7-10
days after vaccination, which may persist for
one year or more provided primary
immunization is completed.
TYPES:
a.PVRV (Purified Vero Cell Rabies Vaccine)
b.PCEVC (Purified Chick Embryo Cell
Vaccine)

PASSIVE IMMUNIZATION
- RIG (Rabies Immune Globulins)
- provide the immediate availability of antibodies
at the site of exposure before it is
physiologically possible for the pt.to begin
producing his own antibodies after vaccination.
- Important for pts. w/ Cat III exposures
Types:
a.HRIG (Human Rabies Immune Globulins)
b.Highly Purified Antibody Antigen Binding
fragments
c.ERIG (Equine Rabies Immune Globulins)

TREATMENT
POST-EXPOSURE TREATMENT (PET)
A.LOCAL WOUND TREATMENT
- Wash with soap/detergent and water
preferably for 10 mins.
- Apply alcohol, povidone iodine/ any antiseptic
- Anti-Tetanus
*Avoid suturing wounds
*Dont apply ointment, cream/ wound dressing

ANTIMICROBIAL
Amoxicillin
Cloxacillin
Cefuroxime
*For those instances where theres 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

VACCINATION
(Intradermal Schedule)
Day of
Immunization

PVRV/PCECV

Site

DAY 0

0.1 ml

L & R deltoids/
anterolateral thighs of
infants

DAY 3

0.1 ml

L & R deltoids/
anterolateral thighs of
infants

DAY 7

0.1 ml

L & R deltoids /
anterolateral thighs of
infants

DAY 28/30

0.1 ml

L & R deltoids/
anterolateral thighs of
infants

Intramuscular Schedule
Day of
Immunization

PVRV

PCECV

Site

Day 0

0.5 ml

1.0 ml

One deltoid/
anterolateral
thigh of infants

Day 3

0.5 ml

1.0 ml

Same

Day 7

0.5 ml

1.0 ml

Same

Day 14

0.5 ml

1.0 ml

Same

Day 28

0.5 ml

1.0 ml

same

Special Conditions:
Pregnancy & infancy are not C/I to treatment
Babies born of rabid mothers should be given
ARV as early as birth as possible
Alcoholics should be given standard IM regimen
Immunocomrpomised individuals- IM
Interchangeability of vaccine brands & shifting
from one regimen to another is not
recommended
Bites of rodents, rabbits, guinea pig- no PET
Dogs, cats, livestock, wild animals- give PET

PET Schedule for previously

immunized patients:
Interval from the last dose

Give

< 1 month

No booster

1 month- 6 months

1 booster dose

> 6 months- 3 years

2 booster doses (D0, D3)

> Than 3 years

Full course of active immun.

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
1.MEDICATIONS
a.Diazepam
b.Midazolam
c.Haloperidol + Dipenhydramine

2. SUPPORTIVE CARE
- Pts w/ confirmed rabies should receive
adequate sedation & comfort care in an
appropriate medical facility.
a.Once rabies diagnosis has been confirmed,
invasive procedures must be avoided
b.Provide suitable emotional and physical
support
c. Discuss & provide important info. to relatives
concerning transmission of dse. & indication
for PET of contacts
d.Honest gentle communication concerning
prognosis should be provided to relatives of pt

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

How can I prevent rabies?

Vaccinate your dogs, cats, and ferrets against rabies.
Keep your pets under supervision.
Do not handle wild animals. If you see a wild animal or a
stray, especially if the animal is acting strangely, call
an animal control officer.
If you do get bitten by an animal, wash the wound with
soap and water for at least 5 minutes. Make sure you
tell an adult and call your doctor to see if you need
shots.
Get your pets spayed or neutered. Pets that are fixed
are less likely to leave home, become strays, and make
more stray animals.

Tick me!
This racoon is eating a special bait which contains a
vaccine against rabies.

How do I keep my pet from getting rabies?

The best way to prevent rabies is to make sure your pets

get and stay vaccinated against rabies!!

Other ways to prevent rabies in your

pets:

Walk your dog on a leash. Never let them roam freely

where wildlife may be present.
Consider keeping your pets indoors.
Call animal control to take wild or stray animals away,
especially if you see an animal acting strangely.
If an animal bites your pet, handle your pet carefully
so you do not get bitten. Get a rabies booster
vaccination for them. Even if they have had the rabies
vaccination, a booster shot will help them fight off
the disease better.
Get your pets spayed or neutered. Pets that are fixed
are less likely to leave home, become strays, and make
more stray animals.
Make sure your pet gets and wears their rabies
vaccination tags. They should also wear a tag with
their name and your address and phone number. Keep
them in a fenced yard or on a leash.

This dog wears a special tag which says

Im rabies vaccinated!

How do I keep from getting rabies?

Never touch unfamiliar or wild animals.

Enjoy wild animals from afar.
Avoid direct contact with stray animals.
Stray cats and dogs may not have been
vaccinated against rabies.
Never adopt wild animals or bring them
into your home.
Do not try to nurse sick animals to health.
It is common to want to rescue and nurse
a hurt wild animal, but that animal may
have rabies. Call an animal control person
or animal rescue group if you find a sick
animal.
Make sure that your trash cans and pet
foods are secured so that they do not
attract wild animals.

QUESTIONS MOST FREQUENTLY ASKED ABOUT RABIES

QUESTION:
Is an increase in the incidence of
rabies r/t El Nio?
ANSWER: No. Rabies both in
humans & animals doesnt in any
way follow a seasonal pattern.

 QUESTION:
Is it true that a dog which is rabid dies only
after it has bitten a person?
ANSWER: No. Whether the dog has bitten
a person or not, a rabid dog dies within 14
days.

 QUESTION:
Is rabies curable?
ANSWER: No. Once signs and symptoms
of brain involvement are manifested, the
rabies victim dies within 1-3 days.

 QUESTION:
Is rabies preventable?
ANSWER: Yes. By administering vaccine
& immunoglobulin at the right time to an
animal bite victim, rabies can be
prevented.

 QUESTION:
If bitten by a stray animal, what should be
properly done?
ANSWER:
A. Immediately wash the bite wound
B. Consult physician/ ABTC
C. Consult a vet for mgt of biting dog

 QUESTION:
Do we need to kill the dog immediately?
ANSWER: No. If the dog is apparently
healthy, it should not be killed immediately
& should be kept on leash / caged for
observation for 14 days.

 QUESTION:
Does a person bitten by a rabid person
need to be given AR immunization?
ANSWER: Yes, a rabid person can
transmit the rabies virus to another person
& need to be given AR immunization.

THANK YOU!
BY
Jane n Jenni

We hope
you enjoyed
the show!

Incubation period

the interval between exposure to infection and the appearance of the first symptom

20-90 days (in 60% of cases), extreme cases

between some days and several years (4 days 2
years)

@ day Tick
0 meHow does the rabies virus interact
Entry of virus
Tick me 1st!
with the nerve cells?

next!

Persistence at site of local entry

hours/days/months
Replication
Passive transport to brain 100-400 mm/ day
pain and paresthesia: numbness, prickling, tingling;
experienced in central and peripheral nerve lesions

How does the rabies

virus interact with
the nerve cells?

There are four main stages the virus goes through:

Attachment: The rabies virus attaches itself to a healthy

nerve cell.

Penetration: The virus is taken in by the cell.

Replication: Inside the cell, the virus multiplies rapidly.

Budding: The new rabies virus leaves the host cell. It

attaches to other nerve cells. The virus then spreads from
the brain to the rest of the body by the nerves.
These different stages are happens during the INCUBATION
PERIOD.

Tick me!

The rabies virus in this picture has been made large so

that you can understand it better.

INVASION STAGE

Also called PRODOME PERIOD; Prodrome symptom indicative of an approaching disease

2-10 DAYS
Sensory changes on the site of entry.
Pain: dull, constant pain referable to the nervous pathways proximal to the location of the
wound or itching, intermittent, stabbing pains radiating distally to the region of inoculation.
In general, sensitivity is the early symptom which may be ascribed to the stimulative action
of the virus affecting groups of neurons, esp. sensory system. Though there is apt to be
decreased sensitivity to local pain e.g. needle introduction, patient may complain bitterly of
drafts & bed clothes which produce a general stimulation
Fever,headache malaise sore throat anorexia increased sensitivity (bright lights, loud
noises) increased muscle reflex irritability, tics and muscle tone
Overactive facial expression

Tick me!

EXCITATION STAGE

Also called ACUTE NEUROLOGICAL PHASE;

hyperactivity
2 10 DAYS
Imminent thoraco-lumbar involvement (SNS):
pupillary dilation, lacrimation increased thick
saliva production / foaming of mouth, excessive
perspiration, increased HR
Anxiety: increased nervousness, insomnia,
apprehension; a strong desire to be up, wandering
aimlessly about, and Fear: a sense of impending
doom
Hydrophobia (perhaps, SNS stimulation:
depresses GI activity > inhibits esophageal,
gastric & intestinal function) > violent expulsion
of fluids, drooling (in attempt not to swallow) >
dehydration and parched mouth & tongue
Pronounced muscular stimulation & general
tremor
Mania (tearing of clothes & bedding, cases of
biting & fighting rare but may occur) and
Hallucinations with lucid intervals (normal mental
function in which patient is well-oriented &
answers questions intelligently)
Convulsions( besides r/t pronounced muscular
stimulation, further precipitated by sensory
stimuli sight, sound, name of water > throat
spasms > choking > apnea, cyanois, gasping
> death, but if patient survive excitement phase
Tick me
Tick me 1st!
next!

Sympathetic nervous system

Parasympathetic nervous
system

Tick me!

PARALYTIC STAGE
-also called DEPRESSION PHASE

Gradual weakness of muscle groups

muscle spasms cease
OCULAR PALSY strabismus, ocular incoordination, nystagmus, diplopia, central type
partial blindness > responds poorly to light, @ times pupil is constricted or unequal
(parasympathetic involvement)
Oro-facial: FACIAL & MASSETER PALSY > difficulty closing eyes & mouth, face
expressionless
Oral: Weakness of muscles of phonation > hoarsness & loss of voice

Loss of tendon reflexes, always precedes weakness of extremity

Corneal reflex decreased or absent, dry

Ears: VERTIGO . Middle ear disease . Early symptom, but may develop @ any period

Neck stiffness

(+) Babinski [lesions of pyramidal tract], ( - ) Kernigs ( - ) Brudzinskis

Cardiac: shifts from tachycardia (100 120bpm) @ bed rest to bradycardia (40 -60 bpm)

Respi: Cheyne-Stokes > breathing pattern characterized by a periodic 10 6- sec of apnea

followed by gradual increasing depth and frequency of respiration

Local sensation (pin prick, heat, cold) diminished

Incoordination

Hydrophobia and aerophobia gone, but still has some difficulty swallowing

General arousal (PNS stimulation)

Bladder & intestinal retention and obstipation (damage to to innervation of the musculature of
intestine & bladder)(SNS damage)
in some cases, patient shows period of recovery, this apparent remission is followed by progressive

Ascending, flaccid paralysis of extremities until it reaches the respiratory muscle

Apathy, stupor
Complications: Pneumothorax, thrombosis, secondary infections
Tick me!

A painting of the US campaign against rabies in wildlife.

Wildlife advocates believe that a vaccinated racoon is the best tool for combating rabies in the wildlife.
Racoons are one of the most common vectors of Rabies. It may eat an infected bat yet may also spread
Tick me!
the virus itself to the bats as it rummages through the bat colony.

SOURCES:
SOURCE:
Tabers Cyclopedic Medical Dictionary 17th Edition. 1994. Singapore: Davis
Company.
Department of Health. Community Health Nursing Services in the Philippine
Department of Health, 9th Edition. 2000. Philippines: DOH
Smeltzer, Suzanne and Bare, Brenda. Brunner & Suddarths Textbook of
Medical-Surgical Nursing, 9th Edition. 2000. Philadelphia: Lippincott Williams
and Wilkins
Geddes and Grossett Limited. Killer Bugs. 1997. New Lanark, Scottland: David
Dale House.
Rivers, Thomas and Horsfall Jr., Frank. Viral & Rickettsial Infections of Man 3 rd
Edition. 1959. Philadelphia: Lippincott Company.
www.pasteur.fr
www.wikipedia.com
www.cdc.com/us/
www.doh.gov.ph
www.ritm.gov.ph (RITM Rabies Research Program)
www.bai.ph (Bureau of Animal Industry Programs)