Spontaneous pneumomediastinum due to paralytic rabies

Rabies is a fatal disease resulting from rabies virus infection, causing severe neurological symptoms and ultimately death by destroying the nervous system. In general, a patient tends to see a neurologist or an infectious diseases physician, with very common and typical discipline-related signs and symptoms, such as hydrophobia, aerophobia, and mental disorders. However, we reported a rabies patient who was first admitted to see a thoracic surgeon with spontaneous pneumomediastinum.

Evaluation of a new premedication protocol for administration of equine rabies immunoglobulin in patients with hypersensitivity.

OBJECTIVES: The present study was undertaken to standardize skin testing and to develop a safe and effective premedication protocol for administration of ERIG in those with skin test positivity/hypersensitivity. METHODS: A method of grading of skin testing was developed using injection histamine as a positive control. This was evaluated by using it on 517 subjects who had severe (WHO category III) exposure to rabies. A premedication protocol consisting of injections pheniramine, ranitidine, hydrocortisone and adrenaline was evaluated by using it on fifty one subjects who were skin test positive/hypersensitive to ERIG. RESULTS: The premedication protocol was safe and effective as all the S1 subjects could be administered the full dose of ERIG despite being skin test positive/hypersensitive to ERIG. Besides the premedication drugs/protocol did not affect the immune response to vaccine and ERIG therapy.

Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil

Foi realizado estudo retrospectivo de nove casos de raiva internados em um hospital de Fortaleza, Brasil. Autópsia foi realizada em todos os casos. As idades variaram de 3 a 81 anos. Todos foram agredidos por cães. O tempo entre o acidente e a admissão hospitalar variou de 20 a 120 dias (média de 45 ± 34 dias). O tempo de internamento variou de 1 a 9 dias (média de 5.5 ± 3.1 dias). Os sinais e sintomas observados foram febre, hidrofobia, aerofobia, agitação, desorientação, dispnéia, sialorréia, vômitos, oligúria, faringite, dor e hipoestesia no local da mordida, cefaléia, síncope, tosse, hematêmese, midríase, hematúria, constipação, dor cervical e priapismo. Em três de seis pacientes (50%) foi encontrada evidência de insuficiência renal aguda, definida como creatinina > 1.4 mg/dL. Os achados de autópsia do tecido renal foram congestão glomerular leve a moderada e congestão capilar peritubular leve a intensa. Necrose tubular aguda foi encontrada em dois casos. Estes achados são inespecíficos, de modo que a instabilidade hemodinâmica, causada por disfunção autonômica, hidrofobia e desidratação podem ser considerados como responsáveis pela insuficiência renal aguda na raiva.

Post exposure management of animal bite cases attending a primary health center of Delhi.

Rabies is an ancient disease of mankind. Every year 4 million people are exposed worldwide after animal bite and around 60000 fell victim to the rabies of which more than 95% of cases are bitten by the dogs. Rabies is a disease associated with many myths. The present study was conducted to find out the clinical profile of the animal bite cases including the common practices, precautions adopted by them after animal bite and lastly the extent and completion of post exposure treatment. Total 147 cases of animal bites attended the OPD during the study. In present study, 123 (83.7%) cases were bitten by dogs, followed by monkey (8.2%) and cat (8.2%). Majority (54.4%) suffered class II bites followed by class I (31.3%) and class III bite (14.3%). Of the total 147 cases, 116 cases (78.9%) completed post exposure prophylaxis which was observed higher among male and in younger age group.

Rabies..Exacerbated problem in Ibn ElKhatib Hospital

Rabies rate increased last 6 months reaching 17 cases admitted to IBN. Al Kateeb hospital, Is caused by RNA virus genus lyssa virus of the rhabdoviridae family. It is primarily an infection of animals but is occasionaly transmitted to man by bites and produce encephalomyelits which is nearly always fatal. In most parts of the world domestic dog is the main vector of human rabies. The virus can pentrate broken skin and intact mucous membranes, also the human rabies resulting from inhalation of the virus is exceptionally rare, and theoritically, Rabies is communicable from person to person. The symptom of either furious or pralytic rabies will develop depending on wether the brain or spinal cord is predominately affected. The diagnosis of rabies can be confirmed in the animal responsible for the bite by immunofluorescene of brain impression smear or histological examination for nigri bodies while in patients rabies can be confirmed early in the illness by antigen detection using immuno fluorescence and by virus isolation from saliva and other secretions. Treatment of rabies is conservative and the prognosis virtually hopeless. At the time of the bite, However before the virus has invaded the nervous system, correct cleaning of the wound and the use of post- exposure immunization reduce the risk of rabies, pre- exposure prophylaxis and post- exposure prophylaxis is essential to prevent the disease

Animal bite management practices: a survey of health care providers in a community development block of Haryana.

It is seen that outcome of animal bites is influenced by various factors including the treatment procedures practiced by health care providers (HCPs). A cross sectional study of health care providers was conducted during May 2000 in PHC Kurali and Naraingarh town of community development block Naraingarh in district Ambala, Haryana. A total of forty-four HCPs were interviewed at their health facility. They were asked about the qualification and number of years in practice. Health care providers were assessed for their knowledge regarding history taking, immediate management of animal bite, post bite anti-rabies treatment, follow up advice and availability of vaccines. Pre-exposure prophylaxis was known to 18.8% of HCPs. Fifty-nine per cent of HCPs were confident in managing dog bites and 93.1% knew about tissue culture vaccine. Vaccine cost was the commonest barrier (38.8%) in the management of animal bites. This study shows a gross difference between awareness and actual practice of management of animal bites.

Case of human rabies in the urban area of Ribeirao Preto, SP, Brazil

Paciente masculino, com 39 anos de idade, foi admitido no Hospital Universitário da Faculdade de Medicina de Ribeiräo Preto com sinais e sintomas repentinos de dispneia, mialgia generalizada e disturbios comportamentais. A suspeita inicial foi de sindrome de abstinencia alcoolica e o paciente foi encaminhado para tratamento psiquiatrico e neurologico. A evoluçäo do paciente foi com piora de sinais e sintomas, presença de crises de taquipneia, agitaçäo, dificuldade de engolir, irritabilidade e hidrofobia e o seu relato de ter sido mordido por um cäo suspeito levou a hipotese de raiva. O diagnostico foi confirmado pelo exame de esfregaço corneal, testes biologicos no liquor...

Mordedura de perro: un accidente frecuente en la consulta diaria al servicio de vacunación del Hospital del Niño Jesús, Tucumán, Argentina / Dog bite. A frequent accident consulted daily at the vaccination service of the Niño Jesús Hospital, Tucumán, Argentina

En el presente trabajo se relacionan las consultas por mordedura de perro con determinados parámetros. El grupo etáreo más comprometido es el de 0 a 15 años (63.8 por ciento), teniendo la mayoría de los accidentes su origen en perros vivos conocidos (80.1 por ciento) y no vacunados (74.9 por ciento), ocurriendo el 52.1 por ciento de las mordeduras en un domicilio. Predominan las lesiones en miembros inferiores (49.6 por ciento). Prácticamente en la mitad de los casos (49.4 por ciento) no hubo motivo aparente para que el animal mordiese. El 62 por ciento de las veces fueron mordeduras únicas.

Un caso de encefalitis rábica de larga evolución: correlación clínico patológica / Human rabies encephalomyelitis of long survival: clinical pathological correlation

Se presenta el caso de un hombre de 22 años de edad que desarrolló encefalomielitis rábica de seis semanas de duración, y que fue tratado inicialmente como padecimiento psiquiátrico y después como encefalitis. Se destaca: 1.- El prolongado tiempo de evolución, ya que lo habitual es que la mayoría de los pacientes fallezcan durante los ocho días posteriores al establecimiento del diagnóstico. 2.- La evidente gliosis reactiva. 3.- Los cuerpos de inclusión en casi todos los cortes estudiados, tanto en la porción supra como en la infratentorial. 4.- Los cuepos de Negri únicos o múltiples y algunos gigantes en las neuronas del hipocampo, así como en las astas anteriores de la médula espinal. 5.- La proliferación de la microglia y la presencia de cuerpos acidófilos libres en el neurópilo. Todo lo anterior indica una larga evolución desde el punto de vista microscópico, lo que raramente se presenta en esta enfermedad. Se revisó la bibligrafía y se encontraron sólo diez casos de larga duración