5-81
Acute Guillain-Barre syndrome (post-infectious polyneuritis) may be clinically similar in presentation, but
usually has an afebrile, symmetric paralysis, often associated with sensory loss.
Plan:
Treatment
Supportive care is indicated, including analgesics for fever or pain (see Procedure: Pain Assessment and
Control). No specific treatment exists for these viruses.
Patient Education
General: Do not expose others to infected body fluids (enteric precautions).
Activity: Rest on firm bed with footboard and sponge rubber pads or rolls. Physical therapy, with early
mobilization after illness, is important during convalescence; brace and lightly splint affected limbs.
Diet: As tolerated.
Prevention and Hygiene: Immunize with inactivated poliovirus vaccine. Eradication of polio has been
achieved in the Western hemisphere and a global campaign is underway using mass immunization to control
outbreaks of disease.
No Improvements/Deterioration: Return for new, recurrent or worsening symptoms.
Follow-up Actions
Return Evaluation: Respiratory compromise or bulbar involvement requires intensive care (airway manage-
ment, assisted ventilation).
Evacuation/Consultation criteria: Evacuate patients suspected of having of polio. Consult infectious
disease or preventive medicine physician for any suspected case of polio.
NOTE: In endemic regions, 90-95% of cases occur before age 6 (median age for polio is 1 year).
ID: Rabies
LTC Niranjan Kanesa-thasan, MC, USAIntroduction Rabies is a fatal, acute, viral encephalomyelitis caused by the rabies virus (a Lyssavirus), which
is endemic to areas of Asia, Africa, and South America. The disease is typified by fever with ascending
paralysis and abnormalities of consciousness and behavior. Illness results from infection through bites,
scratches or licks from an infected animal (dogs, bats or other mammals— rarely other humans). Recent
fatalities in the US may have been exposed through contaminated aerosols in closed environments, e.g., fetid
air in cave filled with bat guano. The incubation period is lengthy (usually 20-90 days) but varies. If recognized
early, active immunization can abort the course of disease. Geographic Association: Worldwide, but has been
successfully kept out of Australia, New Zealand, UK, Ireland, Scandinavia, Japan, Taiwan, Hawaii, other small
islands. Risk Factors: An attack by rabid wild mammals, including bats, foxes, skunks, and other carnivores,
is most suspect. A bite or other exposure from domestic pets, rabbits, or rodents generally conveys little
risk. Worldwide, and particularly in developing countries, dogs are the major reservoir for transmission of
rabies to humans.
Subjective: Symptoms
Tingling or pain at inoculation site (45% of cases); malaise, fatigue, headache or fever for 2-7 days; progres-
sion to apprehension, agitation, hyperactivity, bizarre behavior, hallucinations, nuchal (neck) rigidity, paralysis,
coma and death (99% mortality) over 7-12 days.
Focused History: Have there been behavioral changes or increased aggressiveness in the patient? (sup-
ports the early symptoms of rabies, but not specific unless associated with ascending paralysis) How long
has the patient been ill? (duration longer than 5 days with progression rules out intoxication and some viral
encephalitides) Is there a history of animal bite, exposure to bats, or travel to rabies-endemic area within past
several months? (if yes, increases clinical suspicion of rabies)