The Paralytic Form And General Prognosis And Treatment Of Rabies

This is characterized by ascending paralysis. It may start as monoplegia or paraplegia. Spasms are not prominent. Paralytic form is known to occur more often after vampire bat bites.

Diagnosis: Development of mental excitement, hydrophobia and spasms or paralysis in persons who have sustained bites or licks from any warm blooded animal within six months should suggest the possibility of rabies. Rabies has to be differentiated from psychiatric disorders like maniac excitement and hysteria, encephalitis and other neurological disorders leading to paralysis. Paralytic rabies may be mistaken for adverse reaction to vaccination in persons receiving anti-rabies vaccination. Laboratory diagnosis is made by demonstrating the virus in corneal smears or saliva obtained in the course of the disease, or from brain tissue obtained at autopsy. The virus is identified by neutralization tests. High titer of antibody can be demonstrated in the CSF. Presence of Negri bodies is confirmatory and this can be demonstrated in many of the laboratories undertaking histopathology work. However absence of Negri bodies does not totally exclude the diseases. Special care has to be taken by laboratory personnel while handling autopsy material of suspected cases of rabies to prevent infection.

To confirm the diagnosis of rabies in animals, the whole carcass or the severed head should be packed in ice and sent to the laboratory. Diagnosis is established by demonstrating Negri bodies and vital antigen.

Prognosis: Rabies is an invariably fatal disease and death occurs within five days of the onset of symptoms. There are a few cases on record where inpatients have recovered after showing unmistakable signs of rabies. Life can be prolonged by treatment in intensive care facility.

Treatment: Once the disease is manifested, treatment is only symptomatic. There is no specific treatment. Treatment in the florid case aims at controlling spasms with muscle relaxants, maintenance of hydration by intravenous fluids, and assistance to ventilation. Those who attend on the patients should avoid contamination through saliva by using gloves, masks and protective goggles. Though the virus eliminated in the human saliva is not very virulent, as a matter of abundant caution, attendants who have been inadvertently exposed to very close contact with rabies may be advised to take a course of prophylactic inoculations.