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What is rabies?
Rabies is a fatal disease caused by Rhabdoviridae viruses. Their structure is not particularly entertaining, at least for me. Is is important though, that the virus is vulnerable to high temperatures and sunlight, but it’s resistant to cold and decay processes, that’s why its often can occur in the carcass.
The infection usually occurs by the bite of the wild animal, mostly dogs, cats, foxes or bats. It is second disease that I write about which is caused by foxes, it turns out that they’re kinda dangerous animals. Rabies can be also spread by hares, rodents and squirrels.
The disease seems to be something odd and extraordinary, just like a legend from an ancient times, similar to tuberculosis and syphilis (actually these two lately are not that uncommon, but that’s a topic for another story). WHO estimates that 30-70 thousands people die every year because of the disease. They are mainly residents of poor Asian countries like India, China and Bangladesh. They get infected mostly by the bite of the stray dogs, which are plenty there. Global Alliance for Rabies Control proclaims that many of the victims could be saved if they where become vaccinated. It is impossible there because of the high prices of the vaccines. In wealthy countries like USA, recently increases the amount of infection as a result of a bat’s bite. It is interesting that people can get infected just by the aspiration of the excrement’s particles during the cave expeditions.
The disadvantage in this certain disease is a long incubation period - it usually takes about 2-3 months, exceptionally from a 10 days to even a year. (on the other hand it's a advantage, because we have enough time to react).
When first symptoms occur, patients rarely link it with the bite. The tissues must to be tear to result in the infection. Sometimes it might be enough to slobber the mucous membranes or to have contact with dead animal brain's tissue, which is in fact aggravating the situation (it reminds me of a vet who got infected during careless dissection of a sick animal).
How does the infection happen?
In the moment of bite virions (which are viruses' particles) get to the sceletory muscle cells and next to the neurons, that innervate the muscles. The virus moves several dozens milimeters per day. It travels along the spinal cord's neurons to the brain. There it gets replicated and starts to spread to another tissues. One of the final destination are salivary glands. This is one of the reasons why the most recognizable symptom of rabies occur - hydropobia.
What are the symptoms?
The symptoms are divided to 3 phases: prodromal phase, acute neurological phase and the coma.
The prodromal symptoms, like in the most of infectious diseases, are not typical. Usually patient suffers from headache, fever, fatigue, nausea, vomiting. He might feel excited or anxious. The woud is usually cured but it might be painfull. Due to these uncharacteristic symptoms and if patient wont mention the bite, it is very hard to the doctor to draw the assumption of the rabies.
In this phase encephalitis' symptoms occur such as disturbances of consciousness, hallucination, behavioral changes. There might also appear uncontrolled muscle contractions, salivation and dysphagia. The last two combined participate in the development of the characteristic rabies' symptom called "foaming at the mouth". Disturbances of consciousness occur temporarily and with the progress of the disease the happen more often.
The most typical symptom is hydrophobia, which is caused by uncontrolled, painful contraction of the diaphragm and the respiratory muscles due to the occurrence in the laryngeal and pharyngeal nerves. The contraction is induced as the answer to the irritation of the nerves' endings.
The patients in this stage can also be divided to 2 groups. About 80% will develop stronger brain's symptoms - that's rapid form of the disease. In the rest of the patients neuropathies will be more marked. The neuropaties initially affect only the muscle of the bitten limb, over time they spread to the muscles of the whole body.
this video is very sad to watch. He died probably a week after this video was recorded
With the course of the time the disturbances of the consciousness persist .Patients die in the effect of the dehydration and respiratory. The decease happens generally one week after the appearance of the neurological symptoms.
Did anyone manage to recover?
Since rabies brings about 100% mortality, there were few cases of recovery. The most recognizable one is the story of 15-years old Jeanna Giese. Teenager get bitten on the 12th of September 2004 during the mass in the one of the local churches in Wisconsin. Girl got bitten while she was picking up a bat, which got punched by one of the attendants. The wound was really small and Giese ignored it. The neurological symptoms occurred exactly 37 days after the accident. She got admitted to a local hospital, where M.D. Rodney Willoghby Jr. was working. The doctor knew that she has almost no chance to get well, but he decided to carry out the experiment on her. Results of the research made on the brains of the rabies' victims have proven that virus did not damage the brain cell but it only interfere their work. He decided to "switch off" their brain to give her more time to produce the antibodies. After 6 days occurred some symptoms of the improvement, after a month she got released to home and considered fully recovered. This experimental course was called the Millwaukee protocol. Jeanna Giese was by that one of the 3 people in the world who recover from rabies. Unfortunately later tries of the protocol was unsuccessful. It may suggest that Jeanna was infected with some mild form of the virus.
People still did not invented treatment for rabies. The only thing we can do is prevention.
What to do to not get sick?
Due to long incubation period we have enough time to implement accordant curation to prevent infection. In the person got bitten by a wild animal ( especially when the animal behaves oddly) should immediately visit the doctor. He will estimate the risk of infection and, if it's high, prescribe the after exposition prevention. It consists of using immunoglobulin and vaccines. The immunoglobulin is a artificially produced antibodies, which protect the patient until he produces his own antibodies. It is very important to accurate clean the wound.
To estimate the risk of the infection the doctors can also use veterinary observation. The animal gets isolated for about 10-12 days. If it still lives after this amount of time means that the virus could not be in his saliva in the moment of the bite.
The vaccines are very important part of the prevention. We should consider vaccination when we travel to Asia and Africa.