Sometime ago an article on Rabies was posted by Dr Balasubramanian in our webpage. He emphasised that there should really be no argument about treating a patient confirmed as suffering from rabies through the Milwaukee protocol inspite of the cost. Recently Dr Dharmabalan wrote an article on Rabies in the IMA CGP WhatsApp journal. The article is republished here to remind everyone to be aware of this dreadful disease. The post by Dr Balasubramanian can be accessed through the link – http://www.tnmgc.com/discus/viewtopic.php?f=14&t=319
Dr Dharmabalan wrote: A Brush up with Rabies.

A brush up on Rabies

Rabies is a viral disease caused by Lyssaviruses. It causes acute inflammation of the brain in humans and other warm-blooded animals.

The rabies virus is a bullet-shaped virion with a single-stranded ribonucleic acid (RNA) nucleocapsid core and lipoprotein envelope. Its nucleocapsid material consists of Negri bodies, which are observed in the cytoplasm of infected neurons.

The virus is transmitted in saliva from infected animals, typically via a bite. Globally, dogs are the most common animal involved. In the Americas, bat bites are the most common source of rabies infections in humans.

The time period between contracting the disease and the start of symptoms is usually one to three months; however, this time period can vary from less than one week to more than one year. The time is dependent on the distance the virus must travel to reach the central nervous system.

Rabies is a highly neurotropic virus that evades immune surveillance by its sequestration in the nervous system. Upon inoculation, it enters the peripheral nerves and travels to the brain.

Early symptoms can include fever and tingling at the site of exposure.

80 percent patients suffer from furious rabies, in which they present with episodic delirium, psychosis, restlessness, thrashing, muscular fasciculations, seizures, and aphasia.

20 percent patients develop paralytic rabies in which the patient is relatively quiet compared with a person with the furious form.

Hydrophobia and aerophobia are pathognomonic for rabies and occur in 50% of patients. Attempting to drink or having air blown in the face produces severe laryngeal or diaphragmatic spasms and a sensation of asphyxia.

Once symptoms appear it nearly always results in death.

Animal control and vaccination programs have decreased the risk of rabies from dogs in a number of regions of the world. Immunizing people before they are exposed is recommended for those who are at high risk. In people who have been exposed to rabies, the rabies vaccine and sometimes rabies immunoglobulin are effective in preventing the disease if the person receives the treatment before the start of rabies symptoms. Washing bites and scratches for 15 minutes with soap and water, povidone iodine, or detergent may reduce the number of viral particles and may be somewhat effective at preventing transmission. Only a few people have survived a rabies infection after showing symptoms and this was with extensive treatment known as the Milwaukee protocol.