RABIES

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Roughness is an infectious disease from the group of zoonoses that occurs after biting or moulting the infected animal, characterized by the defeat of the central nervous system. Sporadic cases are registered in most countries of the world.

The causative agent is the virus of the rhabdovirus family. Highly pathogenic to human and warm-blooded animals of all species, as well as birds. It is inactivated by boiling, under the influence of ultraviolet irradiation and under the action of disinfectants (lysol, carbolic acid, chloramine, and thiols).

The source of infection in natural foci are mainly foxes, as well as raccoon dogs, wolves, arctic foxes, jackals, bats (vampires) and other carnivores; In anthro-purgic foci - dogs and cats, less often rodents and herbivores. The infection of a person occurs mainly when the animal is bitten by a diseased animal or if its saliva enters the damaged skin or mucous membranes.

The duration of the incubation period in dogs is 14-16 days. The disease in them is more often manifested by intense excitement. A sick dog gnaws or licking the place of a bite, it is salivating and vomiting , it can escape from the house, attack without barking and bite people and animals, gnaw inedible objects. Rabies can not be. The period of excitation lasts 1-3 days, and then paralysis and death occur. Some sick dogs have no excitement, they usually do not attack people. The rabies virus appears in the saliva of infected animals no earlier than 10 days before the development of clinically expressed symptoms of the disease.

Clinical picture. The incubation period usually lasts 1 -3 months (the deadlines from 10 days to 1 year, the shortest incubation period with a bite to the head). There are three stages of the disease: precursors (depression), stimulation, paralysis. In the first stage (its duration is 1-3 days), the patient has unpleasant sensations in the bite (burning, drawing pain, itching, hyperesthesia of the skin), although the wound has long been healed; Body temperature rises to 37.5 - 38 ° C, there is an unreasonable anxiety, fear, depression, insomnia, rarely increased irritability.

The stage of excitation is characterized by hydrophobia and increased sensitivity to various stimuli. Hydrophobia is manifested by the fact that when you try to drink, and when you approach the lips of a glass of water, the patient has a painful convulsive contraction of the muscles of the pharynx and larynx, breathing becomes noisy, in the form of short convulsions, a short-term respiratory arrest is possible. Such cramps then occur with the sound of pouring water, from the breath of air (aerophobia), from bright light (photophobia), noise (acoustophobia), as well as touching the skin, turning the head, muscle tension. There is a fever , it is often noted increased sweating, salivation, and the patient can not swallow saliva and constantly spits it. Against this background, there are attacks of sharp motor excitement, in some cases with aggressive actions. At the same time, affective disorders are sharply increased, usually manifested by intense fear, and in some cases horror, auditory and visual hallucinations. After the paroxysm of excitement, sharp adynamia sets in, right up to the states reminiscent of prostration. In the intervals between the states of excitation, the patients retain a clear consciousness. After 2 - 3 days, excitement is replaced by paralysis of the muscles of the limbs, tongue, face. Death comes from the paralysis of breathing and the decline of cardiac activity 12 to 20 hours after the onset of paralysis.

The diagnosis is based on a clinical picture, an epidemiological history (animal bite or contact with a suspected rabies animal) and laboratory test results. The dead animals or dead people are examined by the brain (the cerebral cortex, the cerebellum, the medulla oblongata and the ammon horn). The rabies virus antigen can be detected using the fluorescent antibody method in the brain and salivary gland prints. For the detection of specific antibodies, passive hemagglutination reactions, complement fixation, etc. are used.

Treatment is symptomatic. Patients are placed in a darkened and soundproofed room. Enter in large doses of morphine, omnopon , aminazine, diphenhydramine, chloral hydrate in enemas. The use of anti-rabies gamma-globulin in large doses from the first hours of the disease is suggested. Reliable cases of recovery are not described.

Prevention is to combat rabies in animals and prevent the development of the disease in people who have been bitten by sick animals. When bites are recommended to wash the wound with soapy water, cauterize with alcoholic iodine solution and immediately contact the nearest treatment and prophylactic institution. The course of antirabies (Pasteur) vaccinations is carried out with an antirabic vaccine with bites and oslubnenie apparently sick, suspicious of the disease by rabies or unknown animals. Timely vaccination prevents the occurrence of rabies in 96 - 99% of cases. The procedure is carried out in trauma centers, surgical offices of polyclinics, central district hospitals.

When prescribing a course of rabies vaccinations, take into account the severity and localization of the bite, as well as the way of infection (bite, oslubenie), since the duration of the incubation period depends on this in case of rabies. There are light bites (shallow bites of the shoulder, forearm, lower extremities or trunk), of medium severity (superficial single brush bites, scratches, excluding fingers, mucosal lining), and heavy (any bite of the head, face, neck, fingers; Multiple or extensive bites, any bites inflicted by wild carnivorous animals).

With the introduction of even the maximum doses of the vaccine, immunity to the rabies virus appears in humans only on the 12th-14th day, and reaches a maximum level only after 1 month. When bites in the head, fingers, multiple bites, when a short incubation period of the disease is possible (shorter than 30 days), an antirabic immunoglobulin is used .

In the case of mildew, the degree of danger depends on whether the saliva has fallen on intact skin or on the mucous membrane. Since the virus appears in the saliva of an animal no earlier than 10 days before the development of clinically pronounced symptoms of the disease, when bitten by a known, healthy animal, the so-called conditional vaccination course is carried out (2 injections of the vaccine or with severe bites - immunoglobulin). Within 10 days observe the animal. If during this period there are signs of the disease, it dies from rabies (or an unknown cause) or runs away (disappears), then immediately begin an unconditional (full) course of vaccination. If the animal remains healthy within 10 days, no additional vaccinations are given to the injured person. In the case of mildew and light bites, only a 10-day observation of the animal is carried out, and vaccinations are prescribed only in case of disease or disappearance of the animal.

In all cases, when the bite is caused by an unknown or sick animal or the animal is ill, died or disappeared during the observation period, a complete (unconditional) course of vaccinations is carried out. Vaccinations under inpatient conditions are carried out by severely bitten persons who are re-ingested and who have a history of nervous system diseases and allergic diseases, as well as to persons vaccinated during the last 2 months against any infection.

During vaccinations it is necessary to monitor the health of the vaccinated person. When there are complaints of worsening of the general condition, it should be immediately hospitalized, and the anti-rabies vaccinations should be temporarily stopped. Vaccines are prohibited from consuming any alcoholic beverages during the whole course of vaccinations, and also for 6 months after the end of the vaccinations on unconditional indications and for 1 month after the end of vaccinations under conditional indications. It is necessary that during the vaccination period the patient does not overwork, avoid hypothermia, overheat, observe skin hygiene; Should not be vaccinated on an empty stomach.

Registration of dogs, carrying out of preventive rabies vaccinations are obligatory. All rabies-sick animals are sacrificed and taken to the veterinary laboratory for examination. Healthy animals, rabies-bitten animals, make anti-rabies vaccinations, Litter, straw, on which the animal that died from rabies, is burned. The clothes of people in contact with sick animals, stained with saliva, boiled or disinfected in a disinfection room.