Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Rabies 1261

differential diagnosis

In absence of exposure history; little to differentiate rabies from other

viral encephalitides

■Tetanus: Muscle rigidity may resemble rabies/ CSF normal in teta-

nus/usually lucid in tetanus

■Rabies hysteria: a psychological reaction seen in persons exposed to

an animal they believe has rabies

➣Paralytic rabies may resemble other paralytic neurologic disease;

includes poliomyelitis, Guillain-Barre syndrome and transverse

myelitis

management

■Contact isolation is recommended.

■Personnel should avoid contact with patient’s saliva, tears, urine or

other body fluids (virus has not been found in blood).

■Although transmission from patient to hospital staff not docu-

mented, transmission is theoretically possible.

■Reportable

specific therapy

■Once symptoms start, no drug or vaccine improves outcomes.

■Treatment consists of intensive supportive care.

follow-up

n/a

complications and prognosis

Complications

■Almost invariably fatal

■Complications mostly occur during coma phase

➣SIADH

➣Autonomic dysfunction – hypertension, hypotension, cardiac

arrhythmias, hypothermia

➣Seizures: generalized or focal

➣Acute renal failure

➣Secondary bacterial infection of lungs or urinary tract

Prevention

■Prevention is extremely important – if individual is exposed to poten-

tially rabid animal, consult with local health department, consider

post-exposure prophylaxis (PEP)

■Individuals in high-risk occupations (e.g., veterinarians) need pre-

exposure vaccine.