Rage

Description:

Rage is an acute zoonotic disease of a virus etiology which are ill  hematothermal animals and people. The progressing damage of the central nervous system and 100% a lethality is characteristic of a disease.

Rage reasons:

Rage – a viral infectious disease. The neurotropic virus concerns to family Lisovirusov. Have the bullet form. The virus has one-filamentous RNA.
There are 2 types of a rhabdovirus: (wild) and fixed virus circulating under natural conditions among animals street - is applied to receiving an antirabic vaccine.
Replication (reproduction) of a rhabdovirus in nervous cells is followed by formation of little bodies of the Babesa-Negri. The rhabdovirus unstable in external environment, also perishes in 2 minutes of boiling.
As tank serve carnivores – foxes, raccoon dogs, cats, dogs. Bats who allocate a virus in external environment. The highest probability of infection is observed during the spring-year period.
Rage is widespread on all globe, however does not meet in Antarctica, Australia, the island states, and also in Sweden, Spain, Norway and some other states.

Pathogeny:

As entrance gate for a virus serve damages of integuments and mucous membranes. From the place of implementation the rabichesky virus extends on perineural spaces, reaches the central nervous system where it is fixed and begins to be replicated in neurons, a myelencephalon, a hippocampus, brain basis nodes, is localized in a spinal cord. It provides increase in reflex irritability, and the development of paralyzes connected with it. The spasms of respiratory muscles connected with defeat of the wandering, glossopalatine and hypoglossal cranial nerves are observed. The irritation of a sympathetic nervous system causes raised salivary and sweating. Defeat of a vagus nerve provides disturbance in work to cardiovascular system. From the central nervous system the virus "is eliminated" in various bodies, first of all sialadens, adrenal glands, kidneys, skeletal muscles, skin, heart owing to what there are dystrophic changes of a myocardium, hemorrhages in mucous and serous membranes.

Rage symptoms:

The incubation interval lasts from 10 to 90 days. The prodromal phenomena last from 1 to 3 days. The first signs – on site a sting – a swelling, reddening of a wound, a hem, an itch, neurologic pains on the course of the nerve pathways located close to the place of a sting. The indisposition, a headache, hypersensitivity to acoustical and visual irritants, a sleep disorder with nightmares disturbs. The patient feels baseless scare.
In 2-3 days the disease heat period begins. There is short wind and tachycardia, disorders of breath and swallowing. During the paralytic period of a disease reduction of all symptoms, mental calm, the termination of hydrophobia and an aerophobia is observed, there is an opportunity to drink and eat. This phase is called also "ominous calm".
Further paralyzes of upper and lower extremities, cranial nerves develop. Development of paralysis most often goes as ascending Landry's paralysis. Function of pelvic bodies is broken.  Body temperature increases to 42C. Death comes from paralysis of a cordial or respiratory center. The general duration of a disease – from 3 to 7 days.

Diagnosis:

In diagnosis of rage plays very important role эпиданамнез. At a conversation the patient or relatives can report about recent contact with animals.
Material for posthumous diagnosis – bioptata of skin, a brain.
In cuts of a brain it is possible to find eoznofilny little bodies of the Babesa-Negri, the ramer makes them to 10 microns. These little bodies predstalyat sosby accumulation of virus nuklekapsid.
The immunofluorescence method, statement of a bioassey is used.
Modern diagnostic method of a disease is detection of a viral antigen in the prints removed from an eye cover.

Rabies treatment:

Rage – a disease from 100% of a lethality, and pathogenetic treatment does not exist.
Purpose only of a symptomatic treatment – anesthetics, anticonvulsant, hypnagogues is possible. At a stage of development of respiratory frustration carrying out artificial ventilation of the lungs is shown.
In medicine some clinical cases of treatment from rage when displays of a disease already began are known.
So, in the USA in rabid 2005 Geena Gis was entered into an artificial coma against the background of immunostimulation use. After the spent week in a coma the girl was discharged from hospital with recovery. This method of treatment was called by the Milwaukee protocol, however it yields effective result not in all cases.  

Prevention:

Primary and secondary preventive measures concerning rage are developed.
For the purpose of primary prevention vaccination of all domestic and farm animals is carried out. Timely detection of the natural centers of an infection and their destruction is necessary.

Preventive immunization is shown to persons whose profession is connected with the rage raised by risk of infection, for example, hunters, veterinarians, foresters, etc.  

If the sting an animal after all occurred, then it is necessary to deliver an animal to the veterinarian for survey. Such animal is subject to an obligatory 10-day quarantine. If in the specified time the animal remained live and did not change the behavior, then it is probable, it is exciting to ache also risk is not present. Otherwise it is necessary to begin the emergency prevention of rage immediately.  

It is necessary to refer aseptic processing of a wound to methods of nonspecific prevention. The place of a sting is processed flowing water, soap, deep damages need to be washed out by means of a catheter. The wound should be conducted in the open way, without suture.

Specific prevention of rage assumes introduction of a combination of immunoglobulin and an antirabic vaccine.
The most effective method is passive immunization by antirabic immunoglobulin or antirabic serum with the subsequent active immunization (vaccination). Passive and active immunization is carried out at the same time, administering the drugs to different places.

Indications to introduction of antirabic vaccination.
Vaccinal prevention should be begun immediately in the following situations:
- at all stings and other damages of an integument, an oslyuneniya of skin and mucous membranes applied to animals with rage symptoms, suspicious on rage or unknown animals;
- if the wound was given by the subject contaminated by a brain or saliva of a mad animal;
- if the clothes at a sting were damaged by teeth of an animal;
- the sting was carried out through fine or knitted fabric;
- at stings, an oslyuneniya and drawing scratches an animal, healthy at the time of contact, if it within 10 days after that ached, died or disappeared;
- the sting is made by wild rodents;
- at an explicit oslyuneniye or damage of integuments by the person with the diagnosed rage.


Inoculations do not carry out if:
- the sting occurred through very dense or multilayer clothes;
- drawing damages not by birds of prey;
- the sting is put with domestic mice or rats in areas, not epidemic on rage; - at the accidental use of thermally processed meat and milk of mad animals;
- if during the observation period the animal did not get sick;
- the sting is made earlier, than 10 days to estimated infection of an animal;
- at an easy oslyuneniye and superficial stings which were put with animals without clinical displays of rage at favorable data (small probability of a case of rage for  this area, the isolated keeping of an animal, a sting it was provoked by the victim, the animal  is vaccinated against rage). But also in this case for an animal establish observation for a period of 10 days with the purpose to begin inoculations in case of manifestation at an animal of symptoms of rage, and also death or disappearance;
- at the provoked oslyuneniye of the unimpaired integuments an unknown domestic animal in areas, safe on rage;
- in cases of contact with the person, rabid, in the absence of an explicit oslyuneniye of mucous membranes or damage of integuments.

For the purpose of active immunization the vaccine is entered intramusculary on 1 ml of 5 times according to the following scheme: in day of infection, then for the 3, 7, 14 and 28 day. At vaccination according to this scheme it is possible to reach satisfactory immunity. According to recommendations of World Health Organization it is necessary to carry out by 6 more  recommends an injection in 90 days after the first.

In the place of an injection side effects - morbidity, puffiness and consolidation of soft tissues can be shown. Sometimes these reactions are shown in more expressed form. Besides, temperature increase to 38 C and above, dyspepsia, arthritises, increase in lymph nodes is possible. The headache, the general weakness, a fever, a mialgiya and allergic reactions can disturb.

Rage inoculations can be carried out as in out-patient conditions, and permanently. Hospitalization is recommended to persons with heavy stings, to inhabitants rural areas; the persons which are taking root repeatedly; the persons having diseases of a nervous system, the accompanying allergy; pregnant women, and also the persons imparted by other drugs within the previous two months.

Special attention should be paid to vaccination against the background of reception of tsitostatik and corticosteroids. In that case it is necessary to conduct a research of level of antibodies for the purpose of the solution of a question of additional vaccination.

During active immunization it is necessary to watch a condition of the patient. At complaints to an aggravation of symptoms hospitalization is shown, and carrying out inoculations temporarily stops. The patient needs to be consulted at adjacent specialists – the therapist and the neurologist. Further performing vaccination is solved commission survey as a part of the neurologist, a rabiolog and the therapist.

During a course of vaccination and within 6 months after it it is impossible to take alcoholic beverages. It is necessary for ensuring due level of postvaccinal immunity and the prevention of postvaccinal reactions.

Use of other vaccines along with antirabic is not allowed,  the emergency prevention of tetanus can be only in case of need carried out. By sick rage vaccination is not carried out.