October 1, 1998
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Diagnosis & Discussion |
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Clinical Features Premortem diagnosis of rabies is difficult because the prodromal symptoms are often those of a non-specific, influenza type symptoms. The lack of hydrophobia and hypersalivation, symptoms that are typically associated with rabies, as in the case presented by Dr. Gallardo, underscore the difficulty in making a premortem diagnosis of rabies. A history of animal bite is not always elicited in some cases of rabies (see table below).
Rabies should be considered in the differential diagnosis of any rapidly progressive paralytic illness or rapidly progressive encephalitis in which the etiology of the illness is unknown. The classification of rabies as either Dumb/Paralytic Rabies or Irritable (Furious) Rabies is a descriptive classification for rabid animals. Other Diagnostic Techniques Nucleotide sequence analysis is very helpful in the identification of the different strains of rabies virus and is also helpful in elucidating the circumstances under which infection may have occurred. Reverse Transcriptase PCR (RT-PCR) using rabies primers is a method that can be used to detect the rabies virus in formalin fixed paraffin embedded tissues. Rabies Control The United States has implemented stringent control programs for rabies. Pet owners must have their animals vaccinated or face a citation for failure to vaccinate their pet. Humans are warned to avoid stray animals and avoid handling the carcasses of animal that could potentially be rabid e.g. raccoons, foxes, coyotes and bats. Prophylactic pre-exposure and post-exposure vaccines are available for individuals at high risk for infection as well as individuals who have been either exposed to infection or are known to be infected. Human Rabies Immune Globulin (HRIG) is also available for treating infected patients. I think Hawaii is one of the few states in the US that is rabies free. Apparently, Britain is also rabies free and the government intends to maintain this status through strict quarantine laws for incoming animals. Similarly stringent quarantine laws for rabies control are also implemented in other countries. Internet Information About Rabies
A non-scientific personal note I have had two incidents that alerted me to the danger of rabies. My cat Julie strayed and I found her two weeks later in the Dekalb animal control center on the day before she would have been put to sleep. There was a $200 citation because I forgot to have Julie vaccinated against rabies in 1998. (I tell Julie that she is a Bill Gates cat). Seventeen weeks later, I am persuaded to rescue and adopt a beautiful kitten whom I have named Tiger. At the time I got the kitten, I was more concerned about Feline leukemia Virus (FLV) than rabies. He looked very healthy, was very friendly and was vaccinated against rabies (Thankfully FLV negative too). The incidence of rabies is higher in cats than in dogs. However, the incidence of rabies in domestic pets has decreased significantly as a result of the rabies control program. Rabies prevention is much more desirable than the cure which is costly and unpleasant. Karlene Hewan-Lowe |
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