Abigail R.

Ligumbres
BSN IV
RABIES
(Hydrophobia / Lyssa)

Definition

Rabies is a specific, acute, viral infection communicated to man by the

saliva of an infected animal.

Etiologic Agent

Rhabdovirus

1. It is a bullet-shaped filterable virus with a strong affinity to the CNS.

2. It is sensitive to sunlight, ultraviolet light, ether, formalin, mercury, and

nitric acid. The organism is resistant to phenol, merthiolate, and
common antibacterial agents.

Incubation Period

1. One week to seven and a half months in dogs.

2. Ten days to fifteen years in human.

3. Incubation period depends upon the following factors:

a. Distance of the bite to the brain

b. Extensiveness of the bite
c. Specie of the animal
d. Richness of the nerve supply in the area of the bite
e. Resistance of the host

Period of Communicability

The patient is communicable from three to five days before onset of

symptoms until the entire course of illness.

Mode of Transmission

An infected animal carries the rabies virus in its saliva and transmits it to
man by biting. In some cases, the virus spreads when the saliva comes in
contact with the person’s mucus membrane, such as the mouth and the eyelids,
or broken skin like a cut, scratch, or open wound.
Pathology

1. Rabies virus causes widespread changes throughout the CNS.

2. This consists of neural necrosis and mononuclear cellular infiltration

especially in the thalamus, hypothalamus, pons, and medulla.

3. The cranial nerve nuclei are extensively damaged.

4. Neural changes are present in the spinal cords especially in the

posterior horns.

5. Negri bodies are most abundant in the hypo campus, basal ganglia,
pons and medulla, and are found in the degenerating neurons of the
salivary glands (pathologic sign for rabies).

Pathogenesis

1. From the site of the bite, the organism proceeds to the CNS
through the exoplasm of the peripheral nerves.

2. Experimental studies have shown that the virus stays for sometime in
the inoculation site, and the multiplication of the virus occurs in the
myocytes.

3. It has been observe that the period between inoculation and nerve
invasion is the only time when prophylactic vaccine is effective.

4. Once the virus infects the individual, the spread is both centripetal and
centrifugal.

5. After infection of the CNS, the virus spreads through the peripheral
nerves, to the salivary glands, and also to other organs such as the
lungs, the adrenals, the kidneys, the bladder, and the testicles
(priapism).

Clinical Manifestations (3 phases)

1. Prodromal/Invasion phase

a. The phase is characterized by fever, anorexia, malaise, sore

throat, copious salivation, lacrimation, perspiration, irritability,
hyperexcitability, apprehensiveness, restlessness, sometimes
drowsy, mental depression, melancholia, and marked insomnia.
 b. There is pain at the original site of the bite. Headache and
nausea may be present.

c. The patient becomes sensitive to light, sound and temperature.

d. There are pain and aches in different parts of the body.

e. Anesthesia, numbness, tingling, burning, and cold sensation

may be felt along the peripheral nerves involved and the site of
the bite.

f. Mild difficulty in swallowing.

2. Excitement or Neurological Phase

a. This phase is characterized by marked excitation and

apprehension. Terror may even occur.

b. There is delirium associated with nuchal rigidity, involuntarily

twitching or generalized convulsions.

c. The patient may exhibit maniacal behavior, eyes are fixed and
glossy, and the skin is cold and clammy.

d. There is a severe and painful spasm of the muscle of the mouth,

pharynx, and larynx, on attempt to swallow water or food or
even at the mere sight of them.

e. There is aerophobia or intense fear or dislike of flying.

f. There profuse drooling of saliva.

g. There is tonic clonic contraction of the muscles.

h. Death may occur during the episode of spasm or from

cardiac/respiratory failure.

i. If patient survives during this phase, patient deteriorates rapidly

and enters to the terminal phase.

3. Terminal/Paralytic Phase

a. The patient becomes quiet and unconscious.

b. There is loss of bowel or urinary control.

c. Spasm ceases with progressive paralysis.

 d. There is tachycardia, labored, or irregular respiration.

e. Death occurs due to respiratory paralysis, circulatory collapse,

or heart failure.

Diagnostic Procedures

1. Virus isolation from the patient’s saliva or throat.

2. Fluorescent rabies antibody (FRA) provides the most definitive

diagnosis.

3. Presence of negri bodies on the dog’s brain.

Modalities of Treatment

1. Thoroughly wash the wounds from the bite and scratches of dog with
soap and running water for at least 3 minutes.

2. Check the patient’s immunization status. Give tetanus toxoid if needed.

3. Give tetanus antiserum infiltrated around the wound or given

intramuscularly after a negative skin test.

4. Give anti-rabies vaccine, both passive and active, depending upon the
site or extensiveness of the bite as well as the health condition of the
biting animal.

Nursing Management

1. Isolate the patient.

2. Give emotional and spiritual support.

3. Provide optimum comfort.

4. Darken the room and provide a quiet environment.

5. Patient should not bathed and there should not be any running water in
the room or within the hearing distance of the patient.

6. If IV fluid has to be given it should be wrapped and needle should be

securely anchored in the vein to avoid dislodging in times of
restlessness.
 7. Concurrent and terminal disinfection should be carried out.

Common Nursing Diagnosis

• Altered nutrition: less than body requirements

• Fluid volume deficit
• Anxiety
• Knowledge Deficit
• Altered thought process
• Anticipatory grieving

Prevention and Control

The eradication of rabies should be on global scale and should include

measures to prevent and control the disease in animals and wildlife. The primary
preventive measure in rabies is the interruption of the mode of transmission.

1. Vaccination of all dogs.

2. Enforcement of regulations for pick up and distraction of stray dogs.

3. Confinement of any dog that has bitten a person for 10-14 days.

4. Availability of laboratory facilities for observation and diagnosis.

5. Providing public education, especially among children, in avoiding and

reporting all animals that appear sick.