RABIES

:CONTENTS
 (What is rabies? (DEFINITION & ETIOLOGY
Is an acute infectious disease of warm-blooded animals and •
humans characterized by an involvement of the nervous system
. resulting in death
It is caused by the RABIES VIRUS, a rhabdovirus of the genus •
.lyssavirus
Rabies is a serious disease. Each year, it kills more than
50,000 people and millions of animals around the world.
Rabies is a big problem in Asia, Africa, and Central and South
America. In the United States, rabies has been reported in
every state except Hawaii. Any mammal can get rabies.
Raccoons, skunks, foxes, bats, dogs, and cats can get rabies.
Cattle and humans can also get rabies. Only mammals can get
rabies. Animals that are not mammals -- such as birds,
snakes, and fish -- do not get rabies. Rabies is caused by a
virus. An animal gets rabies from saliva, usually from a bite of
an animal that has the disease.
 The Rabies Virus
RV – a neurotropic filterable virus present in the
Rod-shaped rabies
saliva of rabid animals. It has a preferrence for viruses colored for

nerve tissues.
effect

Virus – minute organism not visible with ordinary light

microscopy. It is parasitic in that it is entirely dependent on
nutrients inside cells for its metabolic and reproductive needs.
Can only be seen by use of eclectron microscopy. Consists of
DNA or RNA covered with a protein covering called capsid.
Neurotropic – viruses that reproduce in nerve tissue
Filterable virus – virus causing infectious disease, the essential
elements of which are so tiny that they retain infectivity
after passing through a filter of the Berkefeld type.
Berkefeld filter – a filter of diatomaceous earth designed to
allow virus-size particles to pass through
Diatomaceous earth – substance composed of diatoms, a group
of unicellular microscopic algae that possess a siiceous or
calcium-containing cell wall.

Parts of the rabies virus

A rhabdovirus of the genus lyssavirus.

RHABDOVIRUS: any group of rod-shaped RNA viruses with 1 important

member, rabies virus, pathogenic to man. The virus has a predilection for This is a photograph
tissue of mucus-secreting glands and the Central Nervous System. All of the virus under
warm-blooded animals are susceptible to infection with these viruses. electron microscope

RHABDO: from Greek rhabdos, "rod"

LYSSA: Greek – frenzy, rage, fury, canine madness
 Mononegavirales order

Rhabdoviridae family

genus
vesiculovirus ephemerovirus novirhabdovirus

cytorhabdovirus nucleorhabdovirus

lyssavirus

species

Australian Bat European Bat European Bat Duvenhage virus

lyssavirus lyssavirus 1 lyssavirus 2

Lagos Bat virus Mokola Bat virus

Rabies virus
How do you get rabies? (MODE & MEDIA OF TRANSMISSION, IMMUNITY)

•All warm-blooded mammals are susceptible. Natural immunity in man is

unknown.
•You get rabies through the saliva of an infected animal by an exposure to
an open break in the skin such as bites, open wound or scratch and
inhalation of infectious aerosols such as from bats.
•In some cases, it is transmitted through organ transplants (corneal
transplant), from an infected person.
•The virus gets transmitted through saliva, tears, semen, some liquor
(amniotic fluid, CST) but not blood, urine or stool.

You get rabies from the saliva of a rabid animal, usually

from a bite. The rabies virus is spread through saliva.
You cannot get rabies by petting an animal. You may get
rabies from a scratch if the animal, such as a cat, was
licking its paw before it scratched you. (Remember that
the rabies virus is found in the saliva of an animal).
 ?How do you know if an animal has rabies

Animals with rabies may act differently from •

. healthy animals
: Some signs of rabies in animals are •
changes in an animal’s behavior 
(general sickness (fever, restlessness 
problems swallowing 
increased drooling 
(aggression (biting at inanimate objects, aimless running 

Wild animals may move slowly or may act as if they are tame. Some wild animals •
(foxes, raccoons, skunks) that normally avoid porcupines, may even try to bite these
. prickly rodents
.A pet that is usually friendly may snap at you or may try to bite •
 How do you know if one has
(DIAGNOSIS)
?rabies
•There is yet no way of immediately knowing who had acquired
rabies virus. No tests are available to diagnose rabies in humans
before the onset of clinical disease.

•The most reliable test for rabies in patients who have clinical signs
of the disease is a DIRECT IMMUNOFLUORESCENT STUDY of a
full thickness biopsy of the skin taken from the back of the neck
above the hair line.

•The RAPID FLUORESCENT FOCUS INHIBITION TEST

is used to measure rabies-neutralizing antibodies in
serum. This test has the advantage of providing results
within 24 hours. Other tests of antibodies may take as
long as 14
•days.
 EPIDEMIOLOGY
RABIES INCIDENCE:

WORLDWIDE:35, 000-
50, 000 cases/ year
(WHO)
parts of Africa and Asian continents and many parts of South America are endemic for
rabies
•

UK and most of Western Europe are rabies free due to success of coordinated wildlife
oral vaccination programs
•

annual # of deaths caused by rabies worldwide: 50,000-60,000

•
EPIDEMIOLOGY
PHILIPPINES: 350-450 cases/ year
5-7 per million population

DOG BITE INCIDENCE: 140, 000- 560, 000/ year

200-800 per 100, 000 population/ year
 
AGE MOST AFFECTED: 5-14 year age group
(53% of cases)

BITING ANIMALS: (SLH STUDY 1982- 2002)

 
DOGS: 98%
PET: 88%
  STRAY: 10%
CATS: 2%
 Based on the report from NCDPC (2004), the six •
regions with the most number of rabies cases are
Western Visayas, Central Luzon, Bicol, Central
Visayas, Ilocos and Cagayan Valley

Data shows that 53.7 percent of animal bite patients •

are children

Dogs remain the principal animal source of rabies •

The trend for animal bite cases has increased from 1992 to 2001 but decreased
in the year 2002-2004. The increasing number of patients who are consulting
the health centers for animal bite cases is due to the increasing level of
awareness on rabies. On the other hand, the human rabies cases have been
decreasing from 1995 to 2004. This is due to early provision of post exposure
vaccination to dog bite victims.
In 2004, there were
95,568 animal bite
victims reported with 88
percent of them bitten
by dogs. Of this animal
bite victims, 55,582 or 58
percent had post-
exposure
vaccination and the other
40,000 or so had no
vaccine protection at all.
During the same
year, 228 (0.2 percent of
the total animal bite
cases) were confirmed
cases based on the
appearance of the
unequivocal signs and
symptoms of rabies which
include death for
most.
 Distribution of
Animal Bite
Cases of Cebu
Province
(Jan-June 2006)
?How does rabies affect us
(PATHOPHYSIOLOGY & SIGNS N SYMPTOMS)
What does the virus do?
The targets of the rabies virus are nerve
cells. Nerve cells are one part of the body’s
nervous system. Once inside the body, the
rabies virus infects the nerve cells and
travels along the peripheral nerves (the
nerves that run throughout the body). Its
main target is the central nervous system,
which is made up of the brain and spinal
cord.
How does the virus travel?
When the virus travels from the peripheral
nerves (infected periphery) to the brain, it
is called CENTRIPETAL SPREAD.
The viral travel and spread from the center
(brain) to the periphery is called
CENTRIFUGAL SPREAD.
PATHOLOGY CHART 1: Rabies infection
PATHOLOGY CHART 2: Rabies Infection
STAGES OF RABIES
INFECTION
Rabies virus Entry into the body
INCUBATI0N PERIOD
(20 – 90 days)

INVASION
(0 – 10 days)

EXCITEMENT
(2 – 7 days)

COMA
PARALYTIC (5 – 14 days) DEATH
RABIES CLASSIFICATION
ANIMAL RABIES
There are two common types of rabies. One type is "furious" rabies. Animals with this type are hostile, may •
bite at objects, and have an increase in saliva. In the movies and in books, rabid animals foam at the mouth.
. In real life, rabid animals look like they have foam in their mouth because they have more saliva
The second and more common form is known as paralytic or "dumb" rabies. The dog pictured below has this type.
An animal with "dumb" rabies is timid and shy. It often rejects food and has paralysis of the lower jaw and
.muscles
.Another two types of rabies. One type is “urban” rabies. The type of rabies in domestic dogs and cats •
The other type is called “ sylvatic” rabies. These type came from wild animals such as bats, weasels, skunks and
.moles & voles
HUMAN RABIES
Humans also have a “furious” type, the classic foaming of the mouth, aggression, apprehension & •
.hydrophobia, and the “dumb” type, progressive paralysis of the body until they couldn’t breathe anymore
DIFFERENT STAGES OF RABIES
INFECTION C B
A A
T T
D S S
O
G
S
VIRUS IN SALIVA INHALED AEROSOLS

VIRUS IN SALIVA
INVASION PHASE

INVASION PHASE

PARALY
SIS
EXCITEMENT

PARALY
SIS

DEATH DEATH
 MANAGEMENT
PREVENTION
Responsible pet ownership •
a) pet immunization, esp. cats, usually starting at 3 months of age and every year thereafter
b) don’t allow pets to roam around the streets
c) take care of your pets, keep them in good health – bathe, feed with clean adequate food and
provide clean sleeping quarters
Thoroughly clean ALL BITES AND SCRATCHES made by any animal with strong •
.medicinal soap or solution
Responsible awareness. Report immediately rabid or suggestive of rabies •
domestic or wild animals to proper authorities (local government clinic,
(.veterinarians or community officials
Pre-exposure to high risk individuals. Veterinarians, hunters, people in contact •
with animals (zoo), butchers, lab-staff in contact with rabies, forest
.rangers/caretakers
DOH Standard Protocol •
If dog is apparently healthy, observe the dog for 14 days. If it dies or show signs suggestive or rabies, •
.consult a physician
If the dog shows signs suggestive of rabies, kill the dog immediately and bring head for lab examination. •
.Submit for immunization while waiting for results
If the dog is not available for observation (killed, died or stray), submit for •
.immunization

A cat’s brain for examination

*see DOH- Revised Guidelines on Management of Animal Bite Patients- 2007

for more complete guide
MANAGEMENT
MEDICAL INTERVENTIONS
Local wound treatment. Immediately wash wound with soap and water. Treat with 
.antiseptic solutions such as iodine, alcohol and other disinfectants
.Antibiotics and anti-tetanus as prescribed by physician 
Rabies – Specific Treatment. Post-exposure treatment is given to persons who are 
exposed to the rabies virus. It consists of active immunization (vaccination) and
(.passive immunization (immune globulin administration

ACTIVE IMMUNIZATION – aims to induce the body to develop antibodies and T-cells against
rabies up to 3 years. It induces an active immune response in 7-10 days after vaccination,
which may persist for one year or more provided primary immunization is completed
(MEDICAL AGENT: Human Diploid Cell rabies Vaccine (HDCV

PASSIVE IMMUNIZATION – aims to provide IMMEDIATE PROTECTION against rabies which

should be administered within the first 7 days of active immunization. The effect of the
immune globulin is only short term. Rabies antibodies are introduced before it is
physiologically possible for the patient to begin producing his own antibodies after
vaccination. Some of the RIG is infiltrated around the site and the rest is given
.intramuscularly
(MEDICAL AGENT: Rabies Immune Globulin (RIG
MANAGEMENT
NURSING INTERVENTIONS
HIGH RISK FOR INFECTION TRANSMISSION •
provide patient isolation 
handwashing. Wash hands before and after each patient contact and following procedures that offer contamination risk 
while caring for an individual patient. Handwashing technique is important in reducing transient flora on outer epidermal
.layers of skin
Wear gloves when handling fluids and other potential contaminated articles. Dispose of every after patient care. Gloves 
. provide effective barrier protection. Contaminated gloves becomes a potential vehicle for the transfer of organisms
. Practice isolation techniques. To prevent self-contamination and spread of disease 

(KNOWLEDGE DEFICIT (about the disease, cause of infection and preventive measures •
.assess patient’s and family’s level of knowledge on the disease including concepts, beliefs and known treatment 
:Provide pertinent data about the disease 
organism and route of transmission 
treatment goals and process 
community resources if necessary 
allow opportunities for questions and discussions 

ALTERED BODY TEMPERATURE: FEVER RELATED TO THE PRESENCE OF INFECTION. Since fever is •
.continuous, provide other modes to reduce discomfort
…If patient is still well oriented, Inform the relation of fever to the disease process. The presence of virus in the body 
Monitor temperature at regular intervals 
.Provide a well ventilated environment free from drafts and wind 

DEHYDRATION related to refusal to take in fluids secondary to throat spasms and fear of spasmodic •
. attacks
.Assess level of dehydration of patient 
Maintain other routes of fluid introduction as prescribed by the physician e.g. parenteral routes 
.Moisten parched mouth with cotton or gauze dipped in water but not dripping 
:OBJECTIVES
To provide new policy guidelines and procedure to •
ensure an effective and efficient management for
eventual reduction if not elimination of human
rabies
To increase voluntary pre-exposure coverage •
among high risk group (animal handlers, field
workers, health staff working in rabies unit, rabies
diagnostic lab staff, children ↓ 15 yo living in
.endemic areas
SPECIFIC GUIDELINES AND
:PROCEDURES

Management of
Potential Rabies
Exposure
CATEGORIES OF 3
EXPOSURE
CATEGORY I
Feeding/ touching an animal •
Licking of intact skin (w/ reliable history and •
(thorough physical examination
Exposure to patient with signs and symptoms of •
*rabies by sharing of eating or drinking utensils
Casual contact to patient with signs and •
*symptoms of rabies
 :MANAGEMENT

1.Wash exposed skin

immediately w/ soap and
water

2. No vaccine or RIG needed

*Pre-exposure vaccination may be considered

 CATEGORY II

Nibbling/ nipping of uncovered skin •

with bruising
Minor scratches/ abrasions without •
**bleeding
Licks on broken skin •

includes wounds that are induced to**

bleed
:MANAGEMENT
:Complete vaccination regimen until day 28/30 if

Animal is rabid, killed, died OR unavailable for 14- day •

observation or examination OR
Animal under observation died within 14 days and was •
IMMUNOFLOURESCENT ANTIBODY TEST (IFAT)- positive
OR no IFAT testing was done OR had signs of rabies

:Complete vaccination regimen until day 7 if

Animal is alive AND remains healthy after 14- day •

observation period
Animal under observation died within 14 days but had •
.no signs of rabies and as IFAT- negative
 CATEGORY III

Transdermal bites or scratches ( to include puncture •

(wounds, lacerations, avulsions
Contamination of mucous membrane with saliva (i.e. •
(licks
Exposure to a rabies patient through bites, •
contamination of mucous membranes or open skin
lesions with body fluids (except blood/feces) through
splattering, mouth-to-mouth resuscitation, licks of the
eyes, lips, vulva, sexual activity, exchanging kisses on
the mouth or other direct mucous membrane contact
.with saliva
Handling of infected carcass or ingestion of raw •
infected meat
All Category II exposures on head and neck area •

Does not include sharing of food/ drink/ utensils and*

casual contact with rabid patient
MANAGEMENT
:Complete vaccination regimen until day 28/ 30 if

Animal is rabid, killed, died OR unavailable for 14 day •

observation or examination OR
Animal under observation died within 14 days and was •
IMMUNOFLOURESCENT ANTIBODY TEST (IFAT)- positive
OR no IFAT testing was done OR had signs of rabies

:Complete vaccination regimen until day 7 if

Animal is alive AND remains healthy after 14-day •

.observation period
Animal under observation died within 14 days but had •
no signs of rabies and was IFAT- negative
IMMUNIZATION
ACTIVE IMMUNIZATION
induce antibody and T-cell production in order to -
neutralize the rabies virus in the body. It induces
an active immune response in 7-10 days after
vaccination, which may persist for one year or
.more provided primary immunization is completed
:TYPES
(PVRV (Purified Vero Cell Rabies Vaccine a.
(PCEVC (Purified Chick Embryo Cell Vaccine b.
 PASSIVE IMMUNIZATION
(RIG (Rabies Immune Globulins-
provide the immediate availability of antibodies at -
the site of exposure before it is physiologically
possible for the pt.to begin producing his own
.antibodies after vaccination
Important for pts. w/ Cat III exposures -
:Types
(HRIG (Human Rabies Immune Globulins a.
Highly Purified Antibody Antigen Binding fragments b.
(ERIG (Equine Rabies Immune Globulins c.
TREATMENT
(POST-EXPOSURE TREATMENT (PET •
LOCAL WOUND TREATMENT A.
Wash with soap/detergent and water preferably -
.for 10 mins
Apply alcohol, povidone iodine/ any antiseptic -
Anti-Tetanus -
Avoid suturing wounds*
Don’t apply ointment, cream/ wound dressing*
 ANTIMICROBIAL •
Amoxicillin -
Cloxacillin -
Cefuroxime -
For those instances where there’s no*
obvious signs of infection( Amoxicillin as
(prophylaxis

Educate the public simple local wound***

treatment & warn not to use procedures
that may further contaminate the
wounds
VACCINATION
((Intradermal Schedule
Day of PVRV/PCECV Site
Immunization
DAY 0 ml 0.1 L & R deltoids/
anterolateral thighs of
infants
DAY 3 ml 0.1 L & R deltoids/
anterolateral thighs of
infants
DAY 7 ml 0.1 L & R deltoids /
anterolateral thighs of
infants
DAY 28/30 ml 0.1 L & R deltoids/
anterolateral thighs of
infants
Intramuscular Schedule
Day of PVRV PCECV Site
Immunization

Day 0 ml 0.5 ml 1.0 One deltoid/

anterolateral
thigh of infants
Day 3 ml 0.5 ml 1.0 Same

Day 7 ml 0.5 ml 1.0 Same

Day 14 ml 0.5 ml 1.0 Same

Day 28 ml 0.5 ml 1.0 same

:Special Conditions
Pregnancy & infancy are not C/I to treatment •
Babies born of rabid mothers should be given ARV as early •
as birth as possible
Alcoholics should be given standard IM regimen •
Immunocomrpomised individuals- IM •
Interchangeability of vaccine brands & shifting from one •
regimen to another is not recommended
Bites of rodents, rabbits, guinea pig- no PET •
Dogs, cats, livestock, wild animals- give PET •
PET Schedule for previously
:immunized patients
Interval from the last dose Give

month 1> No booster

month- 6 months 1 booster dose 1

months- 3 years 6< (booster doses (D0, D3 2

Than 3 years< .Full course of active immun

MANAGEMENT OF RABIES
PATIENT
Once symptoms start, treatment should center •
on comfort care, using sedation & avoidance of
intubation & life support measures once
diagnosis is certain

MEDICATIONS 1.
Diazepam b.
Midazolam c.
Haloperidol + Dipenhydramine d.
 SUPPORTIVE CARE. 2
Pts w/ confirmed rabies should receive -
adequate sedation & comfort care in an
.appropriate medical facility
Once rabies diagnosis has been confirmed, a.
invasive procedures must be avoided
Provide suitable emotional and physical b.
support
Discuss & provide important info. to c.
relatives concerning transmission of dse. &
indication for PET of contacts
Honest gentle communication concerning d.
prognosis should be provided to relatives
of pt
 INFECTION CONTROL. 3
Patient should be admitted in a a.
quiet, draft-free, isolation room
HLCR workers & relatives in contact b.
w/ pt should wear proper personal
protective equipment (gown, gloves,
(mask, goggles

DISPOSAL OF DEAD BODIES. 4

 ? How can I prevent rabies

Vaccinate your dogs, cats, and ferrets against 

. rabies
. Keep your pets under supervision 
Do not handle wild animals. If you see a wild 
animal or a stray, especially if the animal is acting
. strangely, call an animal control officer
If you do get bitten by an animal, wash the wound 
with soap and water for at least 5 minutes. Make
sure you tell an adult and call your doctor to see if
. you need shots
Get your pets spayed or neutered. Pets that are 
fixed are less likely to leave home, become strays,
.and make more stray animals

Tick me!
This racoon is eating a special bait which
contains a vaccine against rabies.
 How do I keep my pet from getting rabies?
The best way to prevent rabies is to make sure your pets
!! get and stay vaccinated against rabies
:Other ways to prevent rabies in your pets •
Walk your dog on a leash. Never let them roam freely 
. where wildlife may be present
. Consider keeping your pets indoors 
Call animal control to take wild or stray animals away, 
. especially if you see an animal acting strangely
If an animal bites your pet, handle your pet carefully 
so you do not get bitten. Get a rabies booster
vaccination for them. Even if they have had the rabies
vaccination, a booster shot will help them fight off
. the disease better
Get your pets spayed or neutered. Pets that are fixed 
are less likely to leave home, become strays, and make
. more stray animals
Make sure your pet gets and wears their rabies 
vaccination tags. They should also wear a tag with
their name and your address and phone number. Keep
.them in a fenced yard or on a leash

This dog wears a special tag which says

“I’m rabies vaccinated!”
 ?How do I keep from getting rabies
Never touch unfamiliar or wild animals. 
. Enjoy wild animals from afar
Avoid direct contact with stray 
animals. Stray cats and dogs may not
. have been vaccinated against rabies
Never adopt wild animals or bring them 
. into your home
Do not try to nurse sick animals to 
health. It is common to want to rescue
and nurse a hurt wild animal, but that
animal may have rabies. Call an animal
control person or animal rescue group if
. you find a sick animal
Make sure that your trash cans and pet 
foods are secured so that they do not
. attract wild animals
QUESTIONS MOST FREQUENTLY ASKED ABOUT RABIES

QUESTION:
Is an increase in the incidence
of rabies r/t El Niño?

ANSWER: No. Rabies both in

humans & animals doesn’t in
any way follow a seasonal
. pattern
 QUESTION: •
Is it true that a dog which is rabid
dies only after it has bitten a person?

ANSWER: No. Whether the dog has

bitten a person or not, a rabid dog
.dies within 14 days
 QUESTION: •
Is rabies curable?

ANSWER: No. Once signs and

symptoms of brain involvement are
manifested, the rabies victim dies
.within 1-3 days
 QUESTION: •
Is rabies preventable?

ANSWER: Yes. By administering

vaccine & immunoglobulin at the right
time to an animal bite victim, rabies
. can be prevented
 QUESTION: •
If bitten by a stray animal, what should be
properly done?

: ANSWER
A. Immediately wash the bite wound •
B. Consult physician/ ABTC •
C. Consult a vet for mgt of biting dog •
 QUESTION: •
Do we need to kill the dog immediately?

ANSWER: No. If the dog is apparently healthy, it

should not be killed immediately & should be
kept on leash / caged for observation for 14
.days
 QUESTION: •
Does a person bitten by a rabid person
need to be given AR immunization?

ANSWER: Yes, a rabid person can transmit

the rabies virus to another person & need
.to be given AR immunization
Incubation period
the interval between exposure to infection and the appearance of the first symptom

One week to seven and a half momths in dogs 1.

Ten days to fifteen years in human 2.
:Incubation period depends upon the following factors 3.

Distance of the bite to the brain –

Extensiveness of the bite –
Specie of the animal –
Richness of the nerve supply in the area of the bite –
Resistance of the host –
 How does the rabies
virus interact with
?the nerve cells
:There are four main stages the virus goes through
Attachment: The rabies virus attaches itself to a healthy •
. nerve cell

. Penetration: The virus is taken in by the cell •

. Replication: Inside the cell, the virus multiplies rapidly •

Budding: The new rabies virus leaves the host cell. It •

attaches to other nerve cells. The virus then spreads from
.the brain to the rest of the body by the nerves
These different stages are happens during the INCUBATION
.PERIOD
Tick me! The rabies virus in this picture has been made large so
. that you can understand it better
INVASION STAGE
Also called PRODOME PERIOD; Prodrome – symptom indicative of an approaching disease •
DAYS 2-10 •
.Sensory changes on the site of entry •
Pain: dull, constant pain referable to the nervous pathways proximal to the location of the wound
or itching, intermittent, stabbing pains radiating distally to the region of inoculation. In
general, sensitivity is the early symptom which may be ascribed to the stimulative action of
the virus affecting groups of neurons, esp. sensory system. Though there is apt to be
decreased sensitivity to local pain e.g. needle introduction, patient may complain bitterly of
drafts & bed clothes which produce a general stimulation
Fever,headache malaise sore throat anorexia increased sensitivity (bright lights, loud •
noises) increased muscle reflex irritability, tics and muscle tone
Overactive facial expression •

Tick
me!
 EXCITATION STAGE
Also called ACUTE NEUROLOGICAL PHASE; •
hyperactivity
DAYS 10 – 2 •
Imminent thoraco-lumbar involvement (SNS): •
pupillary dilation, lacrimation increased thick
saliva production / foaming of mouth, excessive
perspiration, increased HR
Anxiety: increased nervousness, insomnia, •
apprehension; a strong desire to be up, wandering
aimlessly about, and Fear: a sense of impending
doom
Hydrophobia (perhaps, SNS stimulation: •
depresses GI activity > inhibits esophageal,
gastric & intestinal function) > violent expulsion of
fluids, drooling (in attempt not to swallow) >
dehydration and parched mouth & tongue
Pronounced muscular stimulation & general tremor •
Mania (tearing of clothes & bedding, cases of •
biting & fighting rare but may occur) and
Hallucinations with lucid intervals (normal mental
function in which patient is well-oriented &
( answers questions intelligently
Convulsions( besides r/t pronounced muscular •
stimulation, further precipitated by sensory
stimuli – sight, sound, name of water > throat
spasms > choking > apnea, cyanois, gasping

death, but if patient survive excitement< •

…phase Sympathetic nervous system

Tick me Parasympathetic nervous system

Tick me next!
1st!
Tick me!
PARALYTIC STAGE also called DEPRESSION PHASE-
Gradual weakness of muscle groups •
muscle spasms cease –
OCULAR PALSY – strabismus, ocular incoordination, nystagmus, diplopia, central type partial –
blindness > responds poorly to light, @ times pupil is constricted or unequal
((parasympathetic involvement
Oro-facial: FACIAL & MASSETER PALSY > difficulty closing eyes & mouth, face –
expressionless
Oral: Weakness of muscles of phonation > hoarsness & loss of voice –
Loss of tendon reflexes, always precedes weakness of extremity •
Corneal reflex decreased or absent, dry •
Ears: VERTIGO . Middle ear disease . Early symptom, but may develop @ any period •
Neck stiffness •
Babinski [lesions of pyramidal tract], ( - ) Kernig’s ( - ) Brudzinski’s)+( •
(Cardiac: shifts from tachycardia (100 – 120bpm) @ bed rest to bradycardia (40 -60 bpm •
Respi: Cheyne-Stokes > breathing pattern characterized by a periodic 10 – 6- sec of apnea •
followed by gradual increasing depth and frequency of respiration
Local sensation (pin prick, heat, cold) diminished •
Incoordination •
Hydrophobia and aerophobia gone, but still has some difficulty swallowing •
(General arousal (PNS stimulation •
Bladder & intestinal retention and obstipation (damage to to innervation of the musculature of •
(intestine & bladder)(SNS damage

in some cases, patient shows period of recovery, this apparent remission is followed by
progressive

Ascending, flaccid paralysis of extremities until it reaches the respiratory muscle •

Apathy, stupor •
Complications: Pneumothorax, thrombosis, secondary infections
Tick •
me!
A painting of the US’ campaign against rabies in wildlife.
Wildlife advocates believe that a vaccinated racoon is the best tool for
combating rabies in the wildlife. Racoons are one of the most common
vectors of Rabies. It may eat an infected bat yet may also spread
Tick the
me!
. virus itself to the bats as it rummages through the bat colony
 :Submitted by
Precious Leanellie U. Guerrero
Hilda G. Guinto