Rabies - Infectious zoonotic disease of viral etiology, characterized mainly by severe lesion of the central nervous system, threatening death. A person infected with rabies through the bite of animals. Spreading along the nerve fibers, the rabies virus initially increases their excitability, and then causes the development of paralysis. Penetrating into the brain and spinal cord tissue virus causes serious violations in the work of the central nervous system, clinically manifested by various phobias, attacks of aggressive driving, hallucinatory syndrome. Rabies is still an incurable disease. For this reason, it is difficult to overestimate the importance of preventive rabies vaccination carried out by the patient in the event of an animal bite.
brain edema, necrosis and degeneration of its tissue.
In the pathological process involves the cells of the cerebral cortex, cerebellum, thalamus and podbugornoy area, as well as the nucleus of cranial nerves. Inside neurons in the brain under the microscope marked eosinophilic education (calf Babes-Negri). Pathological degeneration of cells leads to functional disorders of organs and systems due to nervous disorders. Of the central nervous system the virus spreads to other organs and tissues (lungs, kidneys, liver and endocrine glands, and others.). Hit him in the salivary glands leads to the isolation of the pathogen with the saliva.
depression), there is a gradual change in the patient's behavior. In rare cases, depression is preceded by a general malaise, low-grade fever, pain in the gates of infection (usually already healed wound to the beginning of the disease). Sometimes (rarely) the place of introduction of the pathogen again inflamed. Usually this period is limited to clinical manifestations of the central nervous system (headaches, sleep disturbances, loss of appetite) and mental (apathy, depression, irritability, depression and panic attacks). Sometimes patients may experience chest discomfort (tightness), to suffer digestive disorders (usually constipation).
The height of the disease (excitation stage) occurs 2-3 days after the first signs of depression, is characterized by the development of various phobias: fear of water, air, sound and light. Hydrophobia - fear of water - prevents the patient to drink. The characteristic behavior - when pulling the cup with water, the patient takes it with joy, but the attempt to drink the liquid causes the paralyzing fear of an attack, the suspension of breathing and the patient throws a glass. However, it not always accompanied by a rabies hydrophobia, which can complicate diagnosis. When the disease progresses, patients suffer from severe thirst, but due to the reflex formed even look and sound of water cause respiratory muscle spasms.
Aerophobia is characterized by attacks of breathlessness due to air traffic, with photophobia and akustofobii such a reaction is observed at the noise and bright light. Asthma short duration (a few seconds), they are accompanied by cramps and spasms of mimic muscles, dilated pupils, patients are excited to experience panic, scream, throws her head back. There is a hand shake. Breathing during paroxysms of intermittent, wheezing, breathing in - noisy. The breathing muscles are involved shoulder girdle. During this period, patients are in an aggressive excited state, a lot of shouting, prone to haphazard aggressive activity (rushing, can hit or bite). Typical hypersalivation.
With disease progression excitation attacks are becoming more frequent. Marked weight loss, excessive sweating, there are hallucinations (auditory, visual and olfactory). The duration of the excitation period is 2-3 days, sometimes extended to 6 days.
End-stage disease - paralysis. At that time, patients become apathetic, their movements are restricted, the sensitivity is reduced. Because there is a paroxysm subsided phobic false impression that the patient felt better, but at this time the body temperature rises rapidly, developing tachycardia and hypotension, occur paralysis of limbs, and in the future, and cranial nerves. The defeat of the respiratory and vasomotor center causes cardiac arrest and respiratory depression and death. Paralytic period can last from one to three days.
cerebrospinal fluid and saliva, furthermore, it is possible to diagnose by using fluorescent antibody reaction on biopsies dermis prints cornea. But in view of the complexity and uneconomical, these techniques are not applicable in clinical practice.
Generally diagnosis is carried out on the basis of clinical data and epidemiological history. For diagnostic procedures, the nature of having a lifetime also include bioassays in laboratory animals (newborn mice). While infecting them isolated from saliva, cerebrospinal fluid or lacrimal fluid virus, the mice die within 6-7 days. Histological analysis of the brain tissue of the deceased patient allows definitively confirm the diagnosis in case of detection in cells Babes-Negri bodies.
Currently, rabies is an incurable disease, therapeutic interventions are palliative and aimed at facilitating the patient's condition. Patients hospitalized in the darkened soundproof chamber, they are assigned symptomatic agents: hypnotics and anticonvulsants, painkillers, tranquilizers. Nutrition and rehydration activities carried out parenterally.
Now there is an active testing of new treatment regimens with specific immunoglobulins, immunomodulators, brain hypothermia and intensive care techniques. But so far, rabies is a fatal disease: death occurs in 100% of cases of clinical symptoms.
Prevention of rabies in the first place aimed at reducing the incidence among animals and limit the probability of being bitten stray and wild animals to humans. Pets must undergo routine vaccination against rabies, decreed categories of people (employees of veterinary services, sobakolovy, hunters, etc.) are immunized with rabies vaccine (triple intramuscular administration). A year later, revaccination is made in the future in case of continued high risk of infection, it is recommended immunization repetition every three years.
In the event of an animal bite necessarily produced a set of measures aimed at preventing rabies: the wound is washed with rubbing alcohol, is treated with antiseptics, aseptic bandage is applied, followed immediately contact the emergency station (either the surgeon or the assistant FAP). In no time course conducted preventive rabies vaccination (dry inactivated vaccine) and passive immunization (rabies immunoglobulin). Driving preventive injection depends on the location of the bite, the depth of the wound and the degree of contamination with saliva.