🇮🇳🦠 India accounts for ~36% of global rabies deaths. 😢 Around 20,000 Indians die every year from rabies. 🐶 99% are transmitted by dogs. ☠️ Once symptoms start → fatality approaches 100%. 💉✅ If vaccination is taken on time → disease is almost 100% preventable.

⚠️📢 Public health advice is key.
🚫 Do not dismiss a bite because “it’s my pet”.
🚫⏳ Do not wait to “observe the dog first”.
🚫🩸 Do not judge risk by size of wound or absence of bleeding.
🚫💉 Do not rely only on the dog’s vaccination status.

🚨 Initial Management Summary

⚠️ Early presentation for medical help makes a huge difference in outcome
🧴 Clean wound thoroughly with soap & water for at least 15 minutes.
💉 Start PEP immediately: rabies vaccine + rabies immunoglobulin (RIG) infiltrated into wound if indicated.
⚠️ Late symptomatic rabies → focus on palliative care, as 100% fatal once symptoms appear.

📖 About

🦠 Rabies is a zoonotic viral disease that primarily affects the CNS.
🌍 Rare in the UK and absent in Australia, but common in Asia & Africa.
🐕 Reservoirs: dogs (most common worldwide), bats, raccoons, and wild animals.
Transmission via bites, scratches, or saliva contacting broken skin/mucosa.

🧬 Aetiology & Pathogenesis

Caused by single-stranded RNA Lyssavirus (Rhabdoviridae family).
🎯 Infects local muscle cells → binds to nicotinic acetylcholine receptors at NMJs.
📡 Travels via retrograde axonal transport into CNS.
Spreads to brain → salivary glands → allows host-to-host transmission.

🩺 Clinical Presentation

⏱️ Incubation: 1 week–1 year (typically 20–90 days).
Prodrome: fever, headache, malaise, tingling/itching at bite site.
Encephalitic (furious) rabies (80%):
- Agitation, delirium, ataxia, bizarre/aggressive behaviour.
- 💧 Hydrophobia: pharyngeal spasms on swallowing liquids.
- Hypersalivation, dilated pupils, myoclonus, priapism.
Paralytic rabies (20%):
- Flaccid paralysis starting locally, mimics Guillain–Barré.
➡️ Progresses to coma, seizures, arrhythmias, DIC, death.

🔎 Investigations

🩸 Serology: neutralising antibodies (often negative early).
💉 CSF: mild ↑WCC, ↑protein.
🧠 Histology: Negri bodies in hippocampus & Purkinje cells.
🔬 Skin biopsy: rabies antigen in hair follicle base.
🧪 PCR: detects viral RNA in saliva, CSF, or tissue.

💊 Management

Once symptomatic: Almost universally fatal → palliative care only.
PEP (Post-Exposure Prophylaxis):
- Immediate wound washing with soap & water (≥15 minutes).
- Rabies vaccine series (active immunity, effective in 7–10 days).
- Rabies Immunoglobulin (RIG) infiltrated into wound → passive immediate protection (t½ ≈ 21 days).
🤰 Pregnancy: Vaccine & RIG are safe.
🐕 If possible: euthanize & test offending animal brain tissue (Negri bodies/PCR).
Hydrophobia, agitation, or coma → comfort measures & palliation.

⚠️ Complications

Neurological failure → seizures, coma, brainstem dysfunction.
Autonomic storm → hypersalivation, arrhythmias, temperature instability.
Death usually from cardiorespiratory failure within 2–10 days of symptoms.

💡 Exam Tip: - Think rabies in a traveller returning from Asia/Africa with neurological symptoms + hydrophobia. - PEP = vaccine + RIG → start before symptoms develop. - Once symptoms start → universally fatal → palliation only.

📚 References

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Rabies