Rabies, Rabies or Lyssa is a fatal infectious disease caused by viruses. Mostly rabies is transmitted to humans by wild animals, such as foxes, martens and bats. Not infrequently, however, it is also transmitted by infected feral cats or dogs. Without a vaccination and treatment against rabies, the disease is 100% fatal.
What is rabies?
Infographic on the symptoms and prevention of rabies in humans. Click to enlarge. Rabies is an infectious disease that is mostly transmitted by infected animals, such as foxes or dogs. However, rabies itself is caused by so-called rabies viruses. In addition to dogs and foxes, martens, badgers and bats can also transmit rabies to humans in Germany. Since rabies is systematically controlled in Germany, the probability of being infected by an infected animal has decreased significantly in recent years. Nevertheless, occasional infections do occur. The incubation period of rabies is indicated by research from three to eight weeks. At the same time, the outbreak of the disease is also dependent on the amount of virus transmitted. Rabies is notifiable in Germany and should be treated immediately by a doctor, as the disease can be fatal if left untreated. In Germany itself, only up to three cases of rabies occur per year. In India, however, still 15,000 and in China about 5,000. Travelers to these countries should therefore consider rabies vaccination and seek advice from a doctor.
Causes
The causes of rabies are found in the rabies viruses, which belong to the rhabdo viruses. A transmission or infection with rabies occurs mostly through wound infection such as bites but also through saliva from infected animals or humans. Then the virus spreads in the directly affected muscles of the wound and then continues to multiply via the nerves to the brain. Here, in turn, they enter the salivary glands, such as the pancreas, where they themselves can be further transmitted through saliva, digestive juices and sweat.
Symptoms, complaints and signs
The symptoms of rabies disease can be divided into three stages. In the first stage, the prodromal stage, signs of rabies disease are nonspecific. Patients complain of headache and stomach pain, and there is fever, which can rise sharply as the disease progresses. Vomiting and diarrhea are other common symptoms. If rabies was transmitted by a bite, the wound around the bite site may be itchy. As the disease progresses, increased irritability is observed in patients. Often, affected individuals are sensitive to water, light, drafts, and sounds. The second stage is called the excitation stage. In this stage, the brain of the affected patients is already affected and neurological signs of disease are added to the symptoms of the first stage. For example, patients develop an intense, even panic fear of water, which is also triggered by water sounds such as rushing or splashing and by swallowing their own saliva. As a result, many patients no longer swallow; the larynx may spasm and saliva leaks from the mouth. In atypical cases, symptoms such as seizures, confusion, aggression, and also hallucinations occur in the second stage. In the third stage, the paralysis stage, more and more paralysis occurs in rabies disease, as a result of which the patient falls into a coma. The paralysis symptoms affect all muscles and spread to breathing.
Disease progression
The course of rabies depends on timely recognition of the disease. If the infected person is treated immediately after being bitten by an animal infected by rabies, the chances of recovery are favorable and complications are rare. However, if the brain is affected by the rabies viruses and the typical rabies symptoms appear, the disease can no longer be cured. Death can no longer be averted and can only be delayed by means of intensive care medicine. To date, there has been only one case worldwide in which a patient survived rabies.
Complications
Rabies infection that has already spread to the brain always brings death as a complication. All complications of rabies can be mostly circumvented by prompt vaccination immediately after possible exposure. The mortality rate is almost 100 percent in case of imbedded rabies.So, quickly going to a doctor or hospital after a bite from an animal that tends to be sick, is necessary. Thus, once rabies has spread through the body, it can kill the affected person in several ways. The most common complication leading to death is an onset of coma with respiratory arrest. However, cerebral infarction, meningitis, encephalitis and many other symptoms of the disease also lead to death. The further complications are caused by seizures, appearing hydro- or photophobia, enormous salivation and the further characteristics of an inflammation. The course of an outbreak of rabies is often not properly treated, because especially the paralyses and respiratory depression suggest a disease of Guillain-Barré syndrome. Accordingly, the dying patient is not treated immediately according to his disease (palliative). In addition, when Guillain-Barré syndrome is present, protection from infection by others is not necessary, making transmission of rabies more likely.
When should you see a doctor?
Rabies is a serious disease that requires medical attention in all cases. A doctor should always be consulted after contact with an animal that may be infected with rabies. Even if a conspicuous animal has licked the skin, a rabies vaccination is necessary. The typical symptoms usually appear three to eight weeks after infection. If unusual physical or psychological symptoms occur during this period, a visit to the doctor is recommended. Typical warning signs are headache, gastrointestinal complaints and fever. The painful bite site is the clearest indicator of infection. Emergency medical treatment is needed after a bite. Otherwise, the fever will continue to rise and cause severe physical discomfort. If the sick person vomits his own saliva, the emergency physician must be alerted. People who frequently come into contact with forest animals are particularly at risk. Before a trip to Africa, Asia or Latin America, a precautionary rabies vaccination is recommended. After returning home, the family doctor should be consulted for a routine check-up. The physician can detect any pathogens by saliva examination and initiate appropriate treatment.
Treatment and therapy
After a bite from an animal potentially infected with rabies, as soon as possible the doctor should treat the disease. In the hospital, this involves cleaning the infected wound with a strong soapy solution and water. The aim is to wash out the rabies virus before it can multiply in the muscles. Furthermore, alcohol is used to try to kill the pathogen and disinfect the wound. If the wounds are already very deep, it may also be necessary to flush them out with catheters. These treatment measures always take place in the intensive care unit and are strictly monitored. After washing out, a so-called dead vaccine is administered. This vaccine and additionally administered immunoglobin are intended to immunize the patient against rabies. As a preventive measure, vaccination against tetanus or tetanus is often given as well.
Prevention
The best way to prevent against rabies is with a vaccination. This is not paid by all health insurance companies, but should be considered especially by travelers to America and Asia or veterinarians and hunters. The protection of this vaccination then lasts for 5 years. Further preventive measures are the avoidance of contact with wild and unusually tame or aggressive wild animals. Wild or striking animals should not be touched or should be handled only with the aid of protective gloves.
Aftercare
After initial medical attention to the wound, continue to monitor the bite site for the next 24 to 48 hours. It is important to identify possible possible infections and other complications early. If necessary, these must be treated. The intervals at which these checks are necessary depend on the individual situation. To ensure that the healing process is not jeopardized, the wound must be observed for unfavorable changes. Attention is paid to whether the wound reddens or swells. Joint pain, restrictions in range of motion or fever must also be taken seriously. In this case, a doctor or an emergency ward should be consulted immediately.If the patient does not react in time, a generalized infection such as blood poisoning or sepsis can develop in the worst case. If this remains untreated, death can occur. It is also advisable to have a rabies vaccination after a bite. Here, 20 IU per kilogram of body weight of human rabies hyperimmunoglobulin is administered once by syringe. There are no contraindications against such a vaccination after a bite by an animal suspected of being rabid. Even if the patient does not see a doctor until several weeks or months later after the bite, postexposure vaccination must be administered. Furthermore, it must be checked whether the patient is protected by an adequate tetanus vaccination. If necessary, this should also be refreshed.
What you can do yourself
In the case of rabies, quick action is important. If symptoms of a disease are noticed after an animal bite or contact, such as fever and pain, a doctor must be consulted immediately. Immediate vaccination can often prevent an outbreak of the disease. Careful cleaning of the wound is also important. By using special rinses, a large part of the viruses can be removed before they enter the body. Prophylaxis can also be useful for the relatives of the sick person. After the active and passive vaccination, rest and protection apply. The course must be carefully observed and the active vaccination repeated after three, seven, 14 and 28 days. This can be accompanied by immunoglobulin therapy. After treatment, the cause of the possible rabies infection should be determined. For example, after an animal bite, the animal responsible must be captured and examined. However, prophylaxis takes place before the animal is diagnosed to improve the chances of recovery. If it turns out that the animal is not sick, treatment can be discontinued.
