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.