Rabies in humans. Symptoms, signs as shown, the incubation period, the risk and treatment, grafting

Infectious diseases bring enormous challenges to society and can cause a person to death. Rabies refers to diseases and extremely dangerous without severe symptoms immediately after infection.

Etiology and ways of transmission of rabies

The causative agent is a neurotrophic zoonotic rabies virus affecting the central nervous system and submitted to several strains causing typical and atypical course of the disease. This virus is represented on all continents except Antarctica and Australia.

The most widely received rabies in Africa and parts of Asia.

Rabies virus is killed at high temperatures (above 60 ^aboutC) when subjected to alkali, formalin, chlorine, direct sunlight or ultraviolet rays. Along with this fury is resistant to low temperatures, iodine and phenol.

Congenital or acquired immunity to the rabies virus does not exist. Depending on the source of rabies infection is natural (transmitted by wild animals) and city.

Vector control are carnivorous warm-blooded animals, such as:

• foxes;
• wolves;
• horses;
• skunks;
• cattle;
• jackals;
• raccoon dogs;
• mongoose;
• rodents;
• swine;
• the bats;
• domestic cats, dogs.

In 99% of cases, infection occurs as a result of a dog bite. It is also theoretically possible to catch rabies from a patient person, provided that its saliva enters the body. However, in medicine, such cases were not recorded. Danger of infection not only after the manifestation of obvious symptoms, but also in the end of the incubation period (7-8 days before the active stage).

Infection with rabies virus occurs through the bite or saliva entering an open wound, a scratch, as well as the mucous eye, nose, or intestines. In very rare cases, probably infected by inhalation of air containing a virus (e.g., in the treatment of infected animal skins).

It is also possible to transmit the virus in the transplantation of donor organs. Eating meat infected animal does not entail contamination, since the gastric juice kills the virus. The rate of development of the disease depends on the size of the infected animal, as well as the place of infection (Table 1).

Table 1. Development of rabies depending on where the virus hit:

place falling	The incidence of the disease	the disease
neck, face	90%	rabies lightning occurs with a short incubation period
Hands	63%	the incubation period the average duration of the disease is the usual way
shoulders, legs	23%	long incubation period, the typical course of the disease

Risk of viral infection for humans

Special danger of rabies virus is as follows:

• Rabies does not respond to low temperature, anti-bacterial and anti-viral drugs.
• The infection affects the nerve cells and affects the brain.
• After development, the symptoms of rabies to stop its operation impossible. Treatment of rabies is virtually impossible. Can only alleviate the condition of the patient doomed.
• The virus is always fatal.
• At the initial stage of infection is impossible to ascertain the infection. During this period, there is no pronounced symptoms, but the virus begins to spread throughout the body.
• For virus penetration into the body sufficiently minimal damage to the skin.

incubation period

Rabies in man, the symptoms of which are particularly active in the excitation period at an early stage passes without any symptoms. During the incubation period, the infection spreads throughout the body, penetrating into the neural pathways, and then in the spinal cord and brain. The rate of penetration of the virus is an average of 3-4 mm / hour.

Basically rabies latent phase lasts from 10 days to 3 months. instances of the virus, however, recorded in the history after 1 or even 4 years after getting the infection. The duration of the incubation period depends on the infection site: the further it is from the head, the more time is needed to spread rabies through the body.

Also, thanks to a strong immunity in adults latent phase is longer than in children.

The susceptibility of the nervous system to accelerate the process of infection. If the infection came from a large animal, the disease will be more fleeting. It is also influenced by the size and depth of the wound, through which the virus was in the blood.

In addition, statistics show the dependence of the duration of the incubation phase of the animal, which is a carrier of the virus (if there is a wolf bite the shortest latent period). Rabies can pass without incubation period in the case where the body has penetrated a large number of pathogen cells.

Structure infected with clinical signs of rabies

Rabies refers to infectious diseases that afflict poor people living in areas where there is no vaccine. Also, the clinical manifestations of the virus appear those who refuse to be vaccinated, vaccination takes place lateOr does not pass the full course of injections.

Usually, the infection and further spread of the disease occurs in people who do not have the necessary knowledge about the hazards and methods of prevention of rabies. The virus enters the bloodstream and, because of the lack of necessary measures, infects the entire body, leading to irreversible consequences. When the manifestation of clinical symptoms of rabies in the time comes death.

symptoms

Once in the body, rabies virus initially concentrated in muscle tissue, and then enters the nervous tissue, it completely hitting. The inclusion of the human body formed Babes-Negri, which show the development of disease.

Rabies in humans, the symptoms of which are shown in the time after infection, several stages in its development:

1. hidden (incubation) period;
2. prodromal period;
3. phase excitation;
4. paralytic (terminal) step.

initial stage

The initial symptoms of rabies are connected directly to the site of the bite or infection. The wound starts to itch, ache and swells, even started to heal. Unpleasant sensations are pulling character. In this case, the skin around the wound may become inflamed and blush.

Along with the listed symptoms of lack of appetite, there indifference to all, disturbed sleep, nightmares patient, and bites into the upper half of the body - hallucinations. Also, there is increased blood pressure. The initial stage of rabies development lasts 1-3 days.

The first signs

Rabies in humans, the symptoms of which do not allow to immediately identify the disease at the first signs resemble the common cold: the temperature rises to 37-38 ^aboutC, a headache, fatigue, decreased appetite. In addition, the patient becomes sensitive to loud noises and light.

Also manifested nausea, severe salivation, frequent retching, there is an unjustified feeling of anxiety. On average, such symptoms are observed within 1-3 days. Due to the fact that the disease can be manifested in violent and paralytic form, the first signs of the disease can vary.

When violent manifestations infected behavior becomes too active and the death is inevitable within a few days. Paralytic rabies is less common and lasts longer. The patient begins a gradual paralysis of the muscles on the location of the virus hit, coma and death.

excitation period

After the first period and prodromal symptoms occurs excitation of the active stage. Infection reaches the nervous system and is reflected in the behavior of the patient. At this time, along with the overall hyperactivity occurs most striking symptom of rabies - foam mouth.

Also observed muscular and respiratory spasms, cramps, high fever, reaching 40-41 ^aboutFROM. Breathing in this period greatly disturbed swallowing are observed complexity. Development of rabies is accompanied by chest pain.

In this patient with rabies is extremely aggressive, shouting, smashing everything around. Due to the fact that the patient's haunted by hallucinations and depression hurts, it is dangerous to others and can attack them. Infected during the attack trying to bite or hit the person who is next, or himself.

Due to cramps his face distorted, becomes cyanotic and pupils increased. In most cases the patient suffers from a fear of water, bright light, loud sound or wind gusts. These symptoms are caused by brain damage and central nervous system.

Reaction to stimuli of the nervous system immediately and is accompanied by respiratory disorders, as well as the inexplicable fear. The patient is observed exophthalmos (protrusion of the eyeball) and the treatment look at one point. Also infected suffer excessive salivation. During an attack of aggression possible cardiac arrest.

The patient is disturbed power: he can not fully use food and eating small pieces. Such inappropriate behavior and the state is not constant and alternating with periods of conscious. The patient does not remember anything of what happened, it is calm and easy to go to the contact.

Along with this, there may be a state of apathy. Duration drive period may be 2-3 days. Rabies not always accompanied by a period of excitation, and in this regard, the "silent disease" practically not diagnosed. The source of this variety of the disease is the bite of a bat.

The period of paralysis

If the patient has not died during the active phase of the excitation in the development of rabies occurs paralytic period. Saliva, which is infected can not swallow because of paralysis of the muscles is released along with a cold sweat in large quantities. Aggression and hallucinations disappear, the patient can eat food and drink water. quiet period can last for several days.

Further there is a temperature rise to critical marks (42^aboutC) marked weakness, reduced pressure, impaired sensitivity. At this stage the infected suffers abrupt weight loss due to dehydration. He also stops responding to stimuli, particularly in bright light.

The patient becomes more difficult to move the limbs, and due to the weakening of the facial muscles in his jaw sag.

Typically, a patient with rabies develops paralysis ascending, starting with the lower extremities. Gradually, the paralysis affects the whole body and the person dies of a spasm in cardiovascular heart or lungs. In general, the duration of rabies occurrence is 5-7 days, and the paralysis stage takes no more than a day.

Atypical for rabies

Rabies, depending on the type of virus may also occur outside the box, without major symptoms and without excitation step. It may be absent, and the violent reaction to external stimuli, and hydrophobia. Atypical rabies begins immediately paralytic stage.

Atypical rabies in diagnosis can be confused with other illnesses such as acute encephalitis or Landry paralysis. Misdiagnosis can lead to the spread of infection.

Non-standard course of the disease can cause not only the virus itself, but the regular use of alcohol, cancer processes in the body. Atypical rabies can occur a long period of time (up to 3 months) and be accompanied by diarrhea.

Diagnostics

Diagnose rabies during the incubation period is difficult, because no signs of the disease does not deliver.

Depending on the probabilities of infection and the presence of the contact is isolated from sick animals:

• suspicious event (presence of contact with an animal not established);
• probable case (contact with infected animal was);
• confirmed case (presence of rabies laboratory established by the presence of cells in the nerve cells Babes-Negri at autopsy after death).

Determine whether the patient is infected with rabies with high accuracy is possible only at a lethal outcome during a biopsy, so infection diagnosis begins with anamnesis. First of all, the doctor establishes the existence of direct contact with suspicious animals throughout the year.

Also in the risk zone those patients who, because of professional activities engaged in processing animal hides. In the case of the capture of an animal bite, take analyzes it.

Antibodies to the rabies virus are found in the skin, saliva, cerebrospinal fluid.

In the laboratory, conducted the following tests for rabies:

• immunoflyurestsentny (the study of the brain tissue);
• immunohistochemistry;
• Immunoassay;
• RT-PCR.

Such studies are directly dependent on the stage of infection, the patient's immune system, the virus strain and the technical equipment of laboratories, which carry out the analysis. The most effective method of diagnosis, which showed high sensitivity regardless of when the sample is taken, PCR is considered to be nerve back of the neck.

Rabies in collecting medical history must be differentiated from tetanus and viral encephalitis. When tetanus is not mental impairment, aggression, hydrophobia, and intoxication is present in viral encephalitis. Due to the fact that rabies is always fatal, vaccination is carried out immediately, regardless of whether the infection is confirmed.

rabies treatment in humans

Rabies in humans, the symptoms of which appear only in the active stage, need to be treated before they occur. There is a myth that the rabies infected animal bites a person will not live more than 10 days. However, this statement is false, because with atypical course of the disease virus peddler will live longer.

rabies treatment after onset of his symptoms is impossible in this case reduces to alleviate the disease and the use of maintenance therapy. In connection with this anti-infectious vaccination is carried out in the incubation period. After penetration into the body of the vaccine's immune system starts to produce the required antibodies.

Vaccination must be made no later than 2 weeks after the bite to the immune system could be formed. Patients receiving immunosuppressive drugs and steroids administered over a longer course of treatment, as the effectiveness of vaccine administered in a complex with reduced applied drugs.

In order to form the required number of immune system will need about a month of antibodies. Immunization mandatory spend those in the course of employment is related to virus research or working with animals.

postexposure vaccine

Post-exposure vaccination against rabies carried out immediately after the treatment. Current vaccines more concentrated and allows you to reduce the single dose compared with the previously used drug. Injection children make the outer surface of the thigh, and adults - in the shoulder.

The patient made 6 shots:

• handling;
• on the third day;
• a week later, two;
• one month and 3 months.

If as a result of taking tests in a suspicious animal bite patients, the virus has not been confirmed, the patient made only 3 injections. In that case, if the unknown the fate of the animal, the patient is administered a full course. Efficacy of vaccination with the proviso timeliness (up to 2 weeks after the bite) is 98-99%.

On the effectiveness of such treatment affects compliance within six months after the course of a number of limitations:

• forbidden to drink alcohol;
• contraindicated excessive exercise;
• can not supercool;
• not recommended to be in the bath.

Contraindications have no post-exposure vaccine, and allergic reactions are extremely rare.

In the vaccination is not necessary if:

• saliva contact with intact skin;
• bite through the dense tissue that remained intact;
• damaged skin a bird;
• the bite of the graft during the current year of a pet (if the pet is bitten in the neck, face, or paid a lot of wounded, sick do a minimum of 3 injections).

rabies immunoglobulin

In severe cases (when there are multiple bites and bites in the face, hands, fingers and neck) with the vaccine used rabies immunoglobulin. This preparation is made from horse serum or human blood.

A feature of immunoglobulin application is that it is administered once during the first 3 days after the bite. The preparation is divided into two parts, one of which is introduced into the breech, and the second area cut away around the wound.

Induced coma "Milwaukee Protocol"

After development of clinical symptoms in advanced cases of rabies using an experimental method of treatment called Milwaukee protocol. The basis of this method is the theory that the body has time to develop immunity to the virus, if given the rest of neurons in the human brain by introducing it into an artificial coma.

In a coma reduced metabolism and simultaneously the speed of disease development. At the same time introduced into the organism inhibiting the development of the virus preparations. Milwaukee protocol was applied in 2004 in the treatment of Gina Giese, who became the first survivor of rabies.

Opponents of the use of Jeanna Giese believe that a cure Girl is due to the weakness of the virus strains that she was infected. In addition, the number of survivors in the treatment of an artificial coma does not exceed 15%. Opponents of Jeanna Giese consider this method of treatment in principle deadly.

Such an opinion related to the fact that patients with suspected rabies vaccinations are timely, considering that in case of infection can be cured. Also, the practice of Jeanna Giese quite expensive (about 1 million. dollars) and not affordable for everyone.

Vaccinated against rabies. Schedule of vaccination, the vaccine used, the cost of

Rabies vaccine in the medical practice differ in some features, and price.

Table 2. Rabies vaccine:

Title	Manufacturer	Features	vaccination Schedule	Price
Rabies vaccine culture concentrated purified inactivated dry	Russia	vaccine in solution must not be stored for more than 5 minutes; can cause weakness, fever, malaise; It prohibits the use in conjunction with other antiviral agents.	to 1 ml in the 1st, 3rd and 30th days; booster one year later (1 mL); following revaccination every 3 years (1 mL).	from 2000 rubles.
Rabipur	India	vaccine can not be administered in the breech; It can cause pain at the injection site, and headache	1st, 3rd, 7th, 14th, 30th, 90th days to 1 ml	from 1500 rubles.
Rabies immunoglobulin from the serum of horses	Russia	should be used within 1st day after infection; can cause anaphylactic shock	40 IU per 1 kg of weight once only	from 3000 rubles.

Forecast

After the onset of clinical symptoms of rabies forecast for the development of the disease is unfavorable and ends in death. In the case of the timely administration of the vaccine and the vaccination schedule compliance, as well as the recommendations of the doctor, the patient recover.

The later were injected with the drug against rabies, the lower the chance of survival of the patient. Rabies to humans is tremendous danger. This disease is characterized by the fact that it is necessary to prevent, rather than treat when the first symptoms.

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