0071643192.pdf

INFECTIOUS DISEASE

Fewer than half of rabies

cases due to bats have a

documented bite so treatment

is indicated even if there is no

documented bite, eg, found a

bat in sleeping room.

Rabies wound prophylaxis:

Clean the wound, give the

vaccine, give immune globulin

at the wound site.

Bites from skunks, raccoons,

foxes, and batsare high risk

for rabies. Treat empirically

with both human rabies

immune globulin and vaccine

if unvaccinated.

TABLE 8.11. Postexposure Rabies Prophylaxis

ANIMAL ANIMALDISPOSITION RECOMMENDATIONa

Dog, cat, ferret Healthy/captured Observe animal for 10 days, no treatment

unless clinical signs develop

Escaped Consult public health

Sick H-RIG +HDCV

Skunks, raccoons, Captured H-RIG +HDCV (stop series if euthanized

foxes, bats animal tests negative)

Escaped H-RIG +HDCV

Squirrels, hamsters, N/A Almost never requires treatment (consult

guinea pigs, gerbils, public health for specific recommendations)

chipmunks, rats,

mice, rabbits

aIf treated with preexposure vaccine →finish vaccine course, but do not give H-RIG.

TREATMENT

Symptomatic treatment:

■ ICU admission and supportive care

■ Symptomatic disease almost invariably fatal (normally within a week of onset)

WOUNDPROPHYLAXIS

■ Wound care

■ Aggressive washing with soap and virucidal agent (eg, 2% benzalko-

nium chloride or povidone-iodine)

■ Debridement of devitalized tissue

■ Do not suture.

■ Treatment guidelines (see Table 8.11)

■ Human rabies immune globulin (H-RIG)

■ 20 IU/kg dose at initial treatment

■ Can be given up to 7 days after the first vaccine in the series.

■ As much of the immunoglobulin as possible should be infiltrated

around the wound site.

■ Human diploid cell vaccine (HDCV)

■ IM in deltoid (1-mL doses) on days 0, 3, 7, 14, and 28

A 4-month-old boy presents with 4 days of constipation and poor feeding. He

is afebrile, appears lethargic, and has decreased muscle tone with depressed

deep tendon reflexes. What food product did the child likely consume?

Honey.

Botulism

■ Gram-positive, spore-forming rod Clostridium botulinum.

■ Produces neurotoxin that blocks the release of acetylcholine

■ Results in neuromuscular blockade

■ Potential bioterrorism agent.