patient describes pain in rabies case report

The patient will complain of pain and tingling sensation at the site of the bite wound. Apart from that, the patient might complain of fever, malaise, headache. After about ten days, the patient will develop psychiatric symptoms like marked anxiety, agitation, depression, hallucinations, and change of behavior.

Full Answer

What are the symptoms of rabies in Qom Province?

Forty-five days post-exposure, the patient presented with symptoms such as headache, fever, tingling and burning sensation and was referred to the Centers for Disease Control and Prevention (CDC) unit of Qom Provincial Health Center. Diagnosis: Rabies infection.

How is rabies diagnosed in humans?

Human rabies can be confirmed during clinical disease stage and postmortem by detecting viral antigens, whole virus, or nucleic acids in infected tissues (brain, skin, urine, or saliva) using various diagnostic techniques[1]. Accurate diagnosis of rabies in exposed persons will enable the institution of appropriate care.

How is abortive rabies diagnosed in human survivors?

Notably, the diagnosis of rabies in all human survivors has been based solely on serologic findings, including the presence of VNA, but without virus isolation or detection of viral antigens or RNA ( 2,6 ). Certain other clinical and laboratory findings also support a diagnosis of abortive rabies in the patient described in this report.

What is rabies and how dangerous is it?

Rabies is a neglected tropical disease of poor and vulnerable populations, with deaths due to rabies often not reported. Rabies is nearly always fatal once symptoms appear.

Is body pain symptoms of rabies?

What are the symptoms of rabies?Pain.Fatigue.Headaches.Fever.Muscle spasms.Irritability.Excessive movements.Agitation, aggressiveness.More items...•

How does a rabies patient behave?

As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia. The acute period of disease typically ends after 2 to 10 days. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.

How do you describe rabies?

Rabies is a preventable viral disease most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system of mammals, ultimately causing disease in the brain and death.

Does rabies cause back pain?

Also, several patients had more than one hospital visit for various complaints like lower back pain, neck pain, headache, tremors, tingling of the hands, abdominal pain, fatigue, arm numbness and weakness. Severe abdominal pain7 can be present and even reported as the first disease manifestation.

What does a rabies bite feel like?

At first, there's a tingling, prickling, or itching feeling around the bite area. A person also might have flu-like symptoms such as a fever, headache, muscle aches, loss of appetite, nausea, and tiredness. After a few days, neurological symptoms develop, including: irritability or aggressiveness.

Why do rabies patients bark?

Those that develop the paralytic type of rabies without any evidence of excitation or viciousness may recover on rare occasions. Paralysis of the “voice” muscles in rabid dogs may produce a characteristic change in the sound of the bark. Rabies in humans is similar to that in animals.

Why do patients infected with rabies experience hydrophobia?

People used to call rabies hydrophobia because it appears to cause a fear of water. The reason is that the infection causes intense spasms in the throat when a person tries to swallow. Even the thought of swallowing water can cause spasms, making it appear that the individual is afraid of water.

When do rabies symptoms appear?

In people, the incubation period (the time between initial contact with the virus and onset of the disease) generally ranges from two to eight weeks. In rare cases, it can vary from 10 days to 2 years. The incubation period is shorter in children and in people exposed to a large dose of the rabies virus.

Is sore throat a symptom of rabies?

People with furious rabies will also develop hydrophobia (a fear of water). This initially begins as a pain in the throat or difficulty swallowing. On attempting to swallow, the muscles in the throat go into a brief spasm that lasts for a few seconds.

Can rabies cause abdominal pain?

Conclusions: This paper reports on a case of human rabies with the first disease manifestation (severe abdominal pain).

Is neck pain symptoms of rabies?

In the initial stage, the symptoms are shivering, fever, depression, loss of appetite, nausea, vomiting and headache. The wound can become itchy or painful. During the following (neurological) stage patients may experience hyperactivity, a stiff neck, convulsions and paralysis.

Can rabies cause cramps?

Signs and symptoms associated with rabies include fever, muscle aches, loss of appetite, fatigue, nausea, irritability, headache, agitation, confusion, aggression, weakness, and muscle spasms. As the brain inflammation progresses, other symptoms can include confusion, paralysis, seizures, coma, and death.

Case Scenario

Mr. Luke, a 48-year-old retired police officer, came to see the physician complaining of worsening left arm pain and paresthesia for seven days. On examination, the patient looked agitated and confused with decreased left finger movement.

What is Rabies?

Rabies is a zoonotic infectious disease caused by the rabies virus, a single-stranded RNA virus within the family of rhabdoviruses. It attacks the nervous system causing severe neurological problems, and eventually death of the infected patient. Although it is preventable with vaccines, it has a mortality of 100%.

How Common is Rabies?

Rabies is a major health problem in some countries, with an estimated 55,000 deaths per year worldwide. Most of the developing countries in Asia are victims of rabies. According to the WHO global vaccine research forum, one Asian dies of rabies every 15 minutes, where 15% are mostly under 15 years.

What will the Patient Complain About?

The incubation period for rabies is generally two to three months but may change from one week to one year, depending on the location of virus entry and the viral load. There are two distinct clinical varieties of rabies, namely, furious rabies and dumb rabies. Furious rabies is the classic variety.

What are the Signs We Look for in a Patient?

Even though the patient may complain of pain, abnormal sensation, or an ascending paralysis of the muscles, first, we need to see whether the patient is telling the truth. So, a proper neurological examination with a mental state examination is vital.

How do we Approach the Patient?

As always, we should approach the patient with a good history, examination, and then investigations.

How do We Arrive at a Diagnosis?

The diagnosis of rabies is commonly made with clinical findings. Skin punch biopsies are being used to detect antigens with an immunofluorescent antibody test. Viral RNA can be detected by genome amplification. Isolation of virus from saliva or the presence of antibodies in blood or CSF may support the diagnosis.

What is the presumptive diagnosis of rabies?

With a presumptive diagnosis of rabies, the patient was sedated with ketamine and midazolam and started on amantadine and nimodipine to prevent cerebral artery vasospasm, and fludrocortisone and hypertonic saline to maintain her sodium at a level >140 mmol/L. Neither human rabies immunoglobulin nor rabies vaccine was administered.

What test is performed for rabies?

Serologic tests of CSF and serum for anti–rabies virus antibody, PCR tests of saliva and a nuchal biopsy for the presence of rabies RNA, and direct fluorescent antibody tests of the nuchal biopsy for rabies virus were performed.

What was the cause of the tachycardia in 2011?

On April 25, 2011, a girl aged 8 years visited her pediatrician with a complaint of a sore throat and vomiting when taking sotalol, a medication previously prescribed for her supraventricular tachycardia. Over the next few days, she developed swallowing difficulties and could drink only small amounts of liquids, but was able to carry on with daily activities. Three days after her initial visit, she was seen in a local ED for poor oral intake and was given intravenous fluids to treat dehydration. Two days later, she complained of abdominal pain without localization and neck and back pain, and was brought back to the ED, where she was evaluated and discharged home with a presumed viral illness. The next day, May 1, she returned for a third time to the ED with complaints of sore throat, generalized weakness, and abdominal pain suggestive of appendicitis. On physical examination, she was confused with a pulse of 108 beats per minute, blood pressure of 112/87 mmHg, and temperature of 96.7°F (35.9°C). Head and abdominal computed tomography (CT) were unremarkable. Chest CT was only remarkable for left lower lobe atelectasis. She choked while trying to drink oral radiographic contrast medium. Because of respiratory distress and acidosis shown by arterial blood gas analysis, she was intubated and placed on a ventilator. She was given intravenous fluids, ceftriaxone, and azithromycin and was transferred to a tertiary-care facility.

When was the West Nile virus tested in California?

On May 4, 2011, the California Encephalitis Project at the California Department of Public Health Viral and Rickettsial Disease Laboratory (VRDL) was asked to urgently test for enterovirus (EV) and West Nile virus (WNV). Enterovirus testing was requested because of the well-described cross-reactivity of EV and rhinovirus in molecular testing.

Is rabies a viral disease?

Rabies is a neurotropic viral illness, most commonly transmitted to humans from the bite of an infected animal. Although rabies is preventable with PEP, no proven cure exists after the onset of symptoms ( 1 ). Even with advanced supportive care, the case-fatality rate approaches 100% ( 2 ).

Is M. pneumoniae positive or negative?

The positive M. pneumoniae results were thought to be less significant than the rabies virus diagnostic results because the detection of nucleic acid from a respiratory specimen does not distinguish between infection and colonization and no evidence of M. pneumoniae within the central nervous system could be detected.

Is rabies a neutralizing antibody?

Viral isolation, detection of viral antigens, identification of viral nucleic acid, and detection of rabies virus neutralizing antibodies are not specifically required for diagnosis and are not consistently found in all human rabies cases ( 2 ).

What test is used to detect rabies virus?

On March 11, serologic tests of serum and CSF for antirab ies virus anti bodies, polymerase chain reaction (PCR) tests of saliva and nuchal skin biopsy for the presence of rabies virus RNA, and direct fluorescent antibody tests of the nuchal biopsy for rabies virus antigen were performed at CDC.

What happens if you don't get rabies?

In more typical rabies cases, infected persons who have not received rabies PEP experience a rapid neurologic decline, resulting in death. Human survivors of rabies have demonstrated a vigorous immune response to the virus, as measured by serum and CSF antibody levels ( 2, 4 ).

What is a rabies antemortem?

Laboratory diagnosis of rabies antemortem is based typically on routine detection of viral antigen in a full-thickness skin biopsy, viral RNA in the skin biopsy or saliva, or antibodies in serum and CSF. Only antibodies were found in this patient.

How long does it take for rabies to develop after exposure to bats?

First, the onset of acute encephalopathy approximately 2 months after exposure to bats is compatible with documented incubation periods after rabies virus exposure.

When did rabies come into contact with bats?

On March 10, the medical team elicited a history of bat exposure, and rabies was considered in the differential diagnosis. The patient recalled that approximately 2 months before her headaches began she had entered a cave while on a camping trip in Texas and came into contact with flying bats.

What were the symptoms of a 17 year old girl in 2009?

On February 25, 2009, an adolescent girl aged 17 years went to a community hospital emergency department with severe frontal headache, photophobia, emesis, neck pain, dizziness, and paresthesia of face and forearms. The headaches had begun approximately 2 weeks before she went to the hospital ( Figure ). Her examination was significant for intermittent disorientation, with a Glasgow Coma Score of 14, nuchal rigidity, and fever to 102.0 o F (38.9 o C). Computed tomography of her head was normal. A lumbar puncture (LP) was performed and revealed a white blood cell (WBC) count of 163/mm 3, no red blood cells (RBC), 97% lymphocytes, 3% monocytes, and glucose of 61 mg/dL ( Table 1 ). The patient was treated with intravenous ceftriaxone and dexamethasone, but when CSF bacterial cultures produced no growth, these medications were discontinued. After 3 days in the hospital, the girl's symptoms resolved, and she was discharged home.

How long did the girl stay in the hospital?

After 3 days in the hospital, the girl's symptoms resolved, and she was discharged home. Subsequently, her headaches recurred and intensified; on March 6, she went to another local hospital with photophobia, emesis, and myalgias, particularly of the neck and back.