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MYTHS MYTH BATS ARE ALWAYS

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MYTHS MYTH BATS ARE ALWAYS Powered By Docstoc
					    MYTH: BATS ARE ALWAYS OUR FRIENDS
 24 cases of human rabies have
  occurred in Canada since 1924
 bats eat 20 – 30% of body
  weight in mosquitoes/evening
       are main vector for rabies in
        Canada
       ~4% of bats in SK. are infected
        with the rabies virus
 other vectors include skunks,
  raccoons and foxes
 rare in domestic animals in
  Canada
   beware of bats:
      usually no history of bite

      bat in room with child/sleeping/mentally

       disabled/intoxicated person is indication for
       post exposure prophylaxis
      otherwise seeing a bat is NOT an indication
 can occur post transplant (solid organs, arterial
  grafts, corneas)
 rabies results in 50,000 deaths/year world wide
    usually following a dog bite (10% of all dogs in

     Bangkok are infected with rabies)
    monkey bite is the next most common cause




    Someone dies from rabies every 30 minutes
AN EXTREMELY DIFFICULT DIAGNOSIS

 incubation period is 20 to 60 days but can be up
  to 5 years
 presentations usually “unusual”:
    carpal tunnel syndrome

    atypical neuropathy

 difficulty swallowing secretions is a late sign
  (often 1 week has passed)
 initial workup including CBC, LP and CT scan
  will usually be normal
Suspect rabies in any case of
 febrile encephalitis or flaccid
         paralysis NYD
                        DIAGNOSIS

 arrange through Medical Health Officer
 skin biopsy from nape of neck containing at least
  3 -4 complete hair follicles
 saliva and blood for culture, IgG and IgM testing
 if domestic animals, may observe for 10 days
       if no illness, rabies not present
       if head or neck bite, prophylactic Rx may be started
        immediately
   if high risk wild animal (e.g. bat) destroy and
    send brain for analysis
                     MANAGEMENT

   Milwaukee protocol: therapeutic coma with
    ketamine (which inhibits replication of the rabies
    virus in rats) midazolam and propofol, antiviral
    therapy with ribavirin and amantadine as well as
    supportive therapy resulted in the survival of an
    unvaccinated 14 year-old girl in 2004
       no survivors since
   only 6 known survivors of rabies worldwide

                A mortality rate >99.999%
                        PROPHYLAXIS

   wash wound with copious amount of soap and
    water and 70% ethanol or Betadine if available
       avoid closure
 contact MHO if bat, skunk, raccoon, stray animal
  or rodent acting highly unusual
 standard prophylaxis consists of:
       IM rabies vaccine on days 0, 3, 7, 14 and 28
       one dose of 20 IU/kg of rabies immunoglobulin IM,
        infiltrating as much into the wound as possible
         • within 7 days of first dose of rabies vaccine
YOUR MEDICAL HEALTH
 OFFICER IS YOUR BEST
        FRIEND

				
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posted:6/22/2011
language:English
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