Rabies (Rabees) is an acute zoonotic disease of viral etiology, developing after a human bite by infected animals. The disease is caused by RNA-containing viruses (Rabdarus).

The disease is manifested by the hardest damage to the central nervous system and fatal outcome. Drugs from rabies do not exist. Vaccine from rabies for a man who busted by a sick animal is the only chance to survive. Therefore, vaccination must be immediately carried out.

Most cases of rabies in patients are due to late appealing for specialized assistance, as well as with a violation of the recommended regime during the preventive vaccination or with the incomplete immunization rate.

In most cases, the incubation period for Rabdarusov is from one to 3 months. However, in some cases, this period can be reduced to one week. The duration of the maximum incubation period for rabies virus does not exceed one year.

Due to the fact that the incubation period in some patients can decrease, vaccine-prevention and serotherapy should be fulfilled, immediately after the bite or fascinating the patient's injured skin.

If possible, it is necessary to examine the animal that bites the patient. Animal state monitoring is performed within ten days. At the same time, laboratory tests are carried out on the identification of roblands in the animal.

If there are negative tests of tests and an animal for ten days of observation remains healthy, conducted by a bite man, the prevention of rabies stops.

In this situation, the beginning of the introduction of anti-executive vaccines before obtaining the results of the study is justified by the fact that the drugs from rabies are currently not developed. The disease is distinguished by absolute mortality. All treatment, when manifesting symptoms of rabies in humans, is reduced only to the relief of its condition until the moment of death.

The prevention of rabies in humans, by emergency administration of an anti-cancer vaccine, is the only way to prevent the development of this disease and its consequences.

How can I infect?

Infection of the Rabdarus occurs after a person's bite with an infected animal. Also, infection can occur as a result of the ingress of infected saliva to the areas of affected skin.

In most cases, the infection of urban residents occurs after the bite of the dog. Cases of infection after cat bites are celebrated much less often.

Susceptibility to rabies virus is high, among all warm-blooded animals. Therefore, you can get infected after the bite of any infected animal (bat, rat, squirrel, horse, fox, wolf, etc.).

For reasons of rabies, it is divided into madness of urban and natural type.

A fraction of rural rabies accounts for 2/3 of all cases. This is due to the fact that residents of rural areas are the risk of being branched with mad animals higher than the city inhabitant.

Most often, dog bites, bats and cats become the cause of urban rabies. Flashing of natural rabies, as a rule, are associated with the attack of fox and wolf.

After a bite in the brush, the frequency of rabies development is about seventy percent. The maximum probability of infection and rapid development of the disease with the minimum incubation period falls on bites in the neck area and face (the probability of infection is more than 95%).

In children, rabies occurs more often than adults. This is explained by the fact that children often play with homeless animals and can receive small bites that they do not report adults. Of particular danger at the moment are volatile mice. In this regard, it is categorically not recommended to try to catch the mouse with bare hands that flies into the apartment or on the balcony.

It should be noted that in the states where there are strict restrictions on the import of animals and compulsory vaccinations for them are introduced, there are practically no rabies. Such preventive measures are distributed in Japan, Great Britain, etc.

Whether rabies are transmitted from man to man

The rabies virus is transferred to a person only from an infected animal.

When contacting a busted person, the transmission of the virus does not occur. A single cases of infection are noted during the corneal transfers from a person who deceased from rabies.

In theory, the transfer of a virus from a person with rabies in the terminal stage to another person is possible. However, for this, the patient must not just bite the other person, but also to contact the skin. Either, on the affected area of \u200b\u200bthe skin (open wounds) should get a large number of Slyons of the patient in the terminal stage of rabies.

In practice, people suffer from rabies do not represent epidemiological danger.

Aerially drip or with kisses, rabies virus from person is not transmitted to man.

According to the latest research, the aerogenic transmission mechanism (extremely rare) is possible only when visiting the caves with a huge number of volatile mice.

Is it possible to infect rabies without bite

In addition to bite, infection can occur after entering open damage to the skin or mucous membranes, saliva of the patient of the animal. Infection does not occur if the animal saliva fell on intact skin, for example, the animal could not contact the tight sleeve coat, pants, etc., but at the same time the fabric was impregnated with saliva, which fell on the skin.

Animal examination and conducting a course of prevention (injections from a man's rabies) after the bite or exploring open wounds is mandatory.

In isolated cases, it is possible to vertical transmission of the virus from the mother, busting animals, the child.

How does rabies develop?

The rabies virus in saliva appears eight or ten days before the appearance of signs of the disease. Therefore, even after the bite with the form of a normal, healthy animal, it is necessary to urgently treat the wound with economic soap and consult a doctor for carrying out prevention.

If possible, the animal must also be delivered to the doctor, for its further observation and surveys.

There are two varieties of rabies virus:

• street (wild variants of the virus common among animals);
• fixed (this type of rabies virus is used when creating vaccines).

Both viruses have a similar antigenic nature, therefore, after the introduction of a vaccine made from a fixed strain, immunity develops to a wild virus.

After infection, the Rabdarius spreads through nervous fibers. It is also possible hematogenic and lymphogenic spread of the virus.

The virus is characterized by tropiness to acetylcholine receptors, which contributes to the defeat of many groups of neurons, the development of the hyper-spectrality of the reflex type and in the future, the formation of paralysis.

The brain of an infected person is amazed by eductions, hemorrhages and severe necrotic and degenerative changes. When rabies, there is a defeat of all structures of the brain. The fourth ventricle region is subjected to the highest degenerative changes.

Signs of rabies in humans

The hardest defeat is central nervous system leads to:

• development of convulsive contractions of respiratory and swallowing muscles;
• a sharp increase in savory (selection of saliva and profuse sweating;
• heavy disorders from the respiratory and cardiovascular systems.

Further migration of rabies virus in the body is accompanied by its penetration into all organs and the development of polyorgan insufficiency.

The first signs of rabies in humans is the appearance of the phenomenon of the scar, obscure fears, depressed. In the future, the accession of rabies paroxysms and various phobias is noted.

The phenomenon of the scar is the emergence of a feeling of strongly burning, as well as pulling and stilling pain in the place of bite. The pain spreads through the nervous fibers located at the bite. There is also a strong redness and edema of the scar.

Paroxysms of rabies are called specific reaction Patient on the action of any stimuli. Patients shudder, pulling forward trembling hands (the body also breaks into a small shiver) and learn the head back. It is also characteristic of the appearance of inspiratory shortness of breath (the impossibility of fulfilling a full breath).

The most significant phobias (fears) in rabies will be the occurrence of hydrophobia (water fear), aerophobia (air fear), acousticalophobia (fear of various sounds), photophobia (fear of light).

Classification of rabies

According to the nature of the occurrence, the disease is divided into epizoty of urban and natural rabies.

In clinical forms, bulbar, meningoencephalitic, cerebelchikovo and paralytic forms are isolated.

Periods of the disease are divided into three stages:

• harbingers (first stage);
• excitation (2);
• parali (3).

Also distinguish between the two forms of the course of the disease: violent and paralytic.

The first symptoms of rabies in humans

The first signs of rabies in humans can appear after a week after the bite, however, more often the end of the encubation period of the virus ends after one or three months after the bite.

In patients, the temperature increases (as a rule, the subfebilitation is typical), the phenomenon of the scar develops, complaints about general ailment, the emergence of inexplicably anxiety, depression appear. Sleep disorders are noted, perhaps the emergence of nightmarish dreams and insomnia.

Patients also complain of severe dry mouth, poor appetite, headaches, shortness of breath, tachycardia.

The first stage of rabies lasts from one to three days.

In the second stage, sharply pronounced arousal joins. One of the most specific signs of rabies - sharp hydrophobia appears. The fear of water is so strong that an attempt to bring a patient a glass of water to the lips, causes the appearance of a painful spasm of the larynx and the attack of suffocation.

Patients repel water, despite the sharply pronounced dehydration and the strongest thirst. Specifically pulling forward trembling hands and small twitching of the muscles of the face. Such symptoms appear not only when the patient sees water, but when he hears its sound (open crane).

Aerofobia is manifested by the development of an attack from a blowing of fresh air. In some cases, the attack can be accompanied by sharply pronounced aggressiveness, patients are trying to attack the hospital staff. Periods of aggression and violence are accompanied by a pronounced salivation.

It is noted a sharplification of the person, the ware of the eyes, the expansion of pupils.

After the periods of the richness, the patient comes into itself and is fully aware of what is happening. Also, patients completely remember everything that happened.

After the development of hydrophobia, patients live a few days (rare more than six days).

The patient's fall into the "ominous soothing" is a sign of close fatal outcome. The cause of death is paralysis of cardiac and respiratory muscles.

In isolated cases, quiet rabies options are possible (as a rule, after attacking vampire mice). The disease occurs with the clinic of paralysis without the stage of excitement.

The total rabies duration ranges from five to eight days. A longer course of the disease is extremely rare.

Person's rabies diagnosis

To set the diagnosis of rabies, the collection of anamnesis (animal bite) is extremely important. If possible, the animal must be caught and surveyed.

Specific symptoms of the disease is also taken into account. The diagnosis of rabies is divided into the lifetime and posthumous.

Human rabies analysis

Lifette is carried out using the following:

• virological study of biological material (saliva, spinal fluid);
• PCR, IFA, Reef;
• study of cornea prints.

For post-mortem diagnostics, electronic microscopy of frozen brain tissue, immunohistochemical studies of the brain, as well as conducting MFA or PPA, are used.

All work with rabies virus is carried out only in specialized laboratories in compliance with the strictest security measures and protocols on working with particularly dangerous infections.

Human rabies treatment

Medicines do not exist. All treatment is reduced to the creation for a patient as much as possible conditions and facilitate its condition until death. After death, the body is subject to mandatory cremation.

Attempts to treat anti-libric gamma globulin, but there are no data on their effectiveness.

At the moment, only six cases of survival after rabies are registered. The most famous patient is Gina GIS, which has undergone treatment according to the Miluoka Protocol.

This is an experimental treatment method developed by Dr. Rodney Willububi. Therapy is to introduce a patient to the state of artificial coma (to protect the central nervous system until the body generates antibodies to the virus) and the use of antiviral agents.

The patient spent seven days in a coma. Total treatment occupied on 31 days. The studies carried out later showed that her brain was not injured. Thinking and cognitive features were completely saved.

Prevention and grafting from rabies man

After the bites of animals, it is necessary to immediately rinse the wound with economic soap and running water, to treat with alcohol and iodine. It is strictly forbidden to catch or explore the wound, as it contributes to the spread of the virus.

After treatment in the hospital, the wound is sprinkled with a powder containing anti-libric gamma globulins.

40 injections from rabies in the stomach no longer put. This method is obsolete.

Wafe from rabies to a person must be carried out no later than two weeks from the moment of bite. After the specified period, it is practically not effective.

Rabies vaccination schedule

At the moment, the following fragrance scheme is used for a person for a person: 1 millilitra vaccine five times, on the day of bite. The drug is introduced into the shoulder or thigh. Next, the anti-execution vaccine is introduced into the third, seventh, fourteenth, twenty-eighth (or thirty) and the ninety day after the bite.

Cross for the 28th or 30th day depends on the manufacturer of the vaccine.

With severe bite or late circulation (10 days from the moment of bite), an anti-libric gamma globuline is introduced to the vaccine.

Preventive vaccinations are recommended by persons working with animals, hunters, researchers, veterinarians, etc. The rabies vaccine acts about a year. Therefore, patients who have branched animals during the year after complete course vaccinations, vaccination is shown only on the day of bite + on the third and seventh day.

Preventive vaccinations are conducted when contacting, as well as on the seventh and thirtieth day. A year later, the first revaccination (one introduction) is shown, with the further introduction of the vaccine every three years (one-time introduction of the vaccine).

Compatibility of vaccination against man and alcohol

Alcoholic beverages can not be drunk for six months after grafting from rabies and throughout the course of vaccination.

Alcohol consumption increases the risk of unwanted reactions to vaccination against rabies.

Also contraindicated the use of glucocorticosteroid preparations and immunosuppressants.

Is it possible to wet the vaccination against rabies

In the instructions for vaccines there is no data banning to water the vaccination. However, the vaccination place is not recommended to actively rub during swimming. Also, it is advisable to refrain from visiting a sauna (overheating contraindicated).

During the course of preventive vaccination, overheating, hypotherms or excessive physical activity should be avoided.

Side Effects Vaccinations from Rabies Man

The side effects of the vaccine can manifest itself to the development of edema at the injection site, pain, temperature increase, disapplication gastrointestinal disperses, arthritis, an increase in lymph nodes.

Resters - acute infectious (viral nature) disease of people and animals, characterized by the lesion of the brain substance: when infected, an inflammatory process is developing (encephalitis).

Despite the fact that rabies is one of the most ancient infections, the trends towards its decline so far there are no and effective treatments for treatment. Frenzy remains deadly disease.

Symptoms of the disease are specific, but between infection and the first manifestations of the illness can be pretty for a long time. In this article, we will tell about the treatment and prevention of rabies in humans, because it is very important to know how to protect yourself and their children from dangerous illness.

The widespread rabiness among many types of warm-blooded animals is the danger of infection for people, including children. Most often infection occurs, but it is possible to get a disease and wild animals.

Cause of the disease

Source of infection - Patients animals. Fuck rabies and wild animals (foxes, wolves, bats), and homemade (cats, horses, dogs, pigs, horned cattle), and. In this regard, the city and forest species of rabies distinguish.

Rare cases of infection with a person from a sick person are also recorded.

A person gets a virus with a sick animal bite or with a slouch of skin and mucous membranes. Currently, the possibility of infection with air-droplet is proved.

By this way, people can infect air inhalation in the caves with a large number of bats. The rabies virus can be obtained through food (). It is impossible to exclude the contact path of infection through things that the sick animal hit the saliva.

Children are most susceptible from 5-7 years to 14-15 (more often boys): It is at this age that children will be safely inquired with animals, strive for such contacts, including with homeless cats and dogs.

A group of high professional risk of infection includes hunters, forestry, workers of veterinary service, workers in catching animals. They can become infected from dead animals. Cases of infection through any hand microtraums when removing the skins, the cutting of the patient's animal is registered.

There is a seasonality of the disease: from May to September. During this period, people (children including) spend most of the time on the street than in winter. Frequently sick rural residents, as they have more contact with different animals.

Natural foci of rabies exist everywhere! Patients with rabies Wild animals often run into the nearest settlements where people can attack.

Infectious animals are already 10 days before their signs of rabies, but the greatest danger of infection occurs during the manifestation of the disease.

Not every bite of an infected animal ends with rabies disease. Approximately 30% of damasses of patients with dogs and about 45% of the wolf attacks are infectious for a person. The danger of infection is higher in the bite in the area of \u200b\u200bthe face and head, neck, crotch, the fingers of the upper and lower extremities. Very dangerous deep and ribbon wounds.

Infection can occur even in cases where there is no bite as such, there is simply scratch-track from the teeth or only slouch of the skin and mucous membranes. The virus penetrates the body through skin and mucous membranes.

Symptoms

Incubation period with rabies long, from 1 to 6 months. With extensive wounds and massive infection, the incubation period can be reduced to 9 days. When facial bite, head and neck, the hidden period is short, with the bite of lower extremities - longer. There are cases of rabies development in a year and more after bitching.

In the rabies clinic distinguish 3 periods of the disease:

• premonitory;
• excitation period;
• palsy period.

IN promotional period Diseases appear new pain in the field of concern or bite, even if the wound has already healed. It may be celebrated redness of the scar, itching and burning.

The child increases the temperature within 38 ° C, it worries, and vomiting may occur. The child refuses food, his sleep is disturbed (insomnia appears). If the baby still falls asleep, he sees frightening dreams.

A child during this period is closed, indifferent to what is happening, the mood is depressed, anxious. Face expression dreary. The teenager worries unrelated feeling of fear, gravity in the chest, accompanied and breathing.

The duration of the progress period is 2-3 days (it can be left to 7 days). Subsequently, mental disorders increase, depression and indifference are replaced by anxiety.

IN excitation period The most characteristic for the disease is rabies symptom: hydrophoids (or hydrophobia). When trying to patient, swallow any liquid, even saliva, muscular spasm of larynx and pharynx appears.

The view and even the sound of flowing water, and even talk about water, cause the appearance of fear of fear and the development of such a spasm. When trying to drink the patient, he repels a cup, wound up, leans his head back.

The patient's face is blue, expresses fright: the eyes are somewhat repeated, the pupil is expanded, the glance is fixed into one one point, the breath is difficult, the sweating is enhanced. The attacks of convulsive cuts of muscles, though short-term (last a few seconds), but they are often repeated.

The attack can provoke not only the type of liquid, and the jet of air, a loud knock or sound, bright light. Therefore, the patient develops not only hydrophobia, a and aerophobia, acousticalophobia, photophobia.

In addition to high sweating, there is plenty of formation and salivation. There is psychomotor arousal and manifestation of aggression and rage. Sicks can bite, they spit, can hit, break clothes on themselves.

It is such inadequate violent and aggressive behavior means when people say: "behaves like mad".

During the attack, acknowledging consciousness is noted, frightening visual and auditory hallucinations appear. Between the attacks, consciousness can clarify.

Vomiting, sweating and salivation, the impossibility of receiving the fluid lead to dehydration of the body (it is particularly sharply pronounced in children) and loss of body weight. Temperature may remain elevated.

The excitation period lasts 2 or 3 days, less often up to 5 days. At the height of any of the attacks, the stop of breathing and cardiac activity may occur, that is, death.

In rare cases, the patient can live to the third period of the disease - palsy period. The attacks in this stage are stopped, the patient can already drink and swallow food. Vodoboid disappears. Consciousness in this period is clear.

But this is an imaginary improvement. The body temperature rises above 40 ° C. The pulse is rapidly. The excitement is replaced by lethargy. Depression and apathy increase.

Then the function of the pelvic organs is disturbed, paralysis of limbs and cranial brain nerves develop. Father outcome occurs as a result of the paralysis of respiratory centers and cardiac activity.

In addition to typical form, there is also atypical form rabies. With this form, there is no clear manifestation of periods of the disease; The convulsive attacks of the hydroelectory and the period of excitation may not develop. Clinical manifestations of the disease are reduced to a depressed, driving state with subsequent development of paralysis.

Fear of U. child in early agehas some distinctive features:

• disease develops after a short incubation period;
• hydrophobia is not noted;
• the excitation period is sometimes absent;
• the death of the baby can occur in the first day of the development of the disease.

In children over 2-3 years old, clinical manifestations of rabies are the same as in adults.

Diagnostics

The diagnosis of "rabies" is raised clinically. Even in highly developed countries, it is difficult to confirm the diagnosis. As a rule, confirm it after the death of the patient.

Support for clinical diagnostics Symptoms are:

• fact of bumping or flattened patient skin animals;
• pain at the place of bite after wound healing;
• hydrophobia;
• photophobia;
• aerophobia;
• acousticophobia;
• psychomotor excitation;
• disorders of swallowing and breathing;
• mental disorders;
• paralia.

Due to the lack of a lifetime laboratory diagnosis, atypical forms of the disease in the absence of excitation and hydrophobia are practically not diagnosed. Especially difficult diagnosis of rabies in children, because Establish the fact of the contact of the child with a sick animal is not always possible.

In 2008, the French scientist managed to develop and propose for a lifetime diagnosis to study the biopsy of the neck of the neck (on the border with the growth of the hair) by the IFA method.

The method is highly specific (98%) and highly sensitive (100%) from the first day of the disease. The study allows you to detect the antigen of the virus in the nerve endings near the hair follicle.

With the possibility of carrying out fluorescent antibodies, it is examined to detect the corneal prints of the cornea virus antigen.

When solving the issue of the need for immunoprophylaxis, the diagnosis of rabies in the animal, which caused bite is necessary. This study is carried out in the earliest time after the patient's bite (if the corpse of the animal is available to take samples of biological tissues). In this case, you can find a virus in the cells of the brain and cornea of \u200b\u200bthe eyes or sections of animal skin with serological reactions and the method of fluorescent antibodies.

Treatment

Treatment of a patient with rabies is carried out only in the hospital. The conditions of the patient's content should exclude the effects of bright light (the chamber with darkened windows), loud noise stimuli and air flows.

Effective rabies therapy has not been developed. A weak therapeutic effect is anti-libric immunoglobulin, anti-library serum and large doses.

Symptomatic treatment is carried out:

• painkillers to reduce pain;
• anticonvulsant drugs;
• sleeping pills in sleep impaired;
• the introduction of solutions to normalize the water-salt balance;
• medicinal preparations for stimulating the work of the heart and respiratory system;
• treatment in the barocamera (hyperbaric oxygenation);
• cerebral hypothermia (ice bubble on the head);
• connecting an artificial respiratory device (by testimony).

The outcome of the disease is unfavorable, patients die. Describes single events of children's recovery worldwide.

Prevention

Our country has a specific and non-specific prevention of rabies.

Non-specific prophylaxis Provides such measures:

• calves and isolation of stray animals;
• identification of mad animals by the veterinary service with their subsequent onset;
• extermination of predatory animals near settlements;
• quarantine events and laboratory diagnostics in a focus of infection;
• sanitary and educational work among the population.

Specific prophylaxis It is carried out by conducting a course of combined administration of an anti-cancer vaccine and an anti-liblical immunoglobulin after a bite or exploration of animals. After the bite, the wound processing should be carried out and consult a surgeon.

Wound processing is carried out as follows:

• rinse to rinse the wound with boiled soap water or hydrogen peroxide;
• treat wound or 70 ° alcohol;
• sewing wounds, as well as excision of its edges, contraindicated;
• around the wound and in the wound itself an anti-library immunoglobulin is introduced;
• after 24 hours, anti-library serum is introduced.

The first two point of processing should be held at home, even before visiting the doctor; The rest holds a surgeon.

Given the destructive effect on the high temperature virus, in the field conditions can be used by an old method of processing wounds after an animal bitter: causticing wounds from the bite by rotable gland.

To destroy the virus, you can put a crystal of mangartanous or carbolic acid.

In the case of busting, the doctor clarifies the doctor, under what circumstances a bite was obtained, whether he was provoked by the patient's behavior, whether the animal is wondering and where the animal is now. If the fabricated animal is great (there is a certificate of vaccination), then vaccination is not carried out.

If the animal is lost after applying a bite, or in the case of the patient's bumping, the anti-cancer vaccine and anti-liblobuline vaccination is carried out by wild animals.

The vaccination scheme is selected to the patient (especially a child) by a doctor individually: depending on the depth and localization of the bite, the limitation of the bite, from which animal caused a bite and is it possible to observe him.

If, after a 10-day observation of the pet, which caused a bite, it remains healthy, then the introduction of the vaccine is canceled after 3 injections already obtained (if there is a slouch or shallow single bite).

But if the bite was inflicted in dangerous places (listed above), as well as in the absence of the ability to observe or examine the animal, enter the vaccine continues to the end of the appointed scheme.

• inclusion of mucous membranes;
• bite (any depth and quantity) in the dangerous places listed above;
• deep single or multiple pets deposited by pets;
• any damage or fascinations of wild animals or rodents.

An anti-cancer vaccine is introduced intramuscularly to the shoulder area, and to children under 5 years to the region of the upper third of the front surface of the thigh. In the buttocks enter the vaccine can not. The vaccine has a prophylactic effect even in the case of multiple heavy bites.

Persons from a group of professional risk of infection are carried out primary prevention of anti-cancer vaccine. Preventive introduction of vaccine and early children, given what they can and not tell about contact with animals.

Preliminary prevention can also be carried out with children when planning vacation in rural areas or in a healthy summer camp.

The vaccine is introduced according to 1 ml intramuscularly 3 times: after 7 and 28 days after the first introduction. Persons from the risk group of infection revaccination is carried out every 3 years. Adults and children after vaccination must be excluded overheating, avoid overwork. When conducting vaccination and for six months after it, it is necessary to categorically exclude the use of any species and doses. Otherwise, complications may arise from the CNS.

Summary for parents

Given the fact that rabies are almost impossible to cure, it is necessary to take all measures to prevent the child's infection. It follows to children from an early age to explain the danger of contact with stray cats and dogs. Little children should not be left unattended to eliminate attack and animal bites.

Frenzy - severe infectious pathology, developing in a person after the bite of cats, dogs, wild animals. This disease is characterized by severe symptoms and very often ends with the death of man.

Almost before end XIX. Centuries People did not have any means against this disease, and any treatment was unsolved, therefore, the person who infected them from domestic or wild animals was doomed to death. Then a vaccine against rabies was developed, which allowed to stop the disease on early stages and save busting patients. The honor and recognition of the creation of the vaccine earned the French scientist Louis Pasteur - it was he who made the first vaccinations from rabies and saved his life to a small patient.

The reasons

Frenzy is caused by a virus that refers to the Rhabdovtrida - NeuroIYCC Rabid family. Pathogenic for a person is a street virus that circulates in nature, at the same time under the conditions of the laboratory, scientists create a so-called fixed virus, based on rabies vaccine.

The question is relevant - how is rabies transmitted? The disease is transmitted through the infected saliva after the bite of a sick person and an animal. Most often, the source of virus transmission is dogs (up to 60% of all cases of infection), less frequent pathology causes foxes, cats and other animals. The most unpleasant thing is that at the animals themselves at the time of their attack on a person (or other animals) signs of rabies are still missing - they are dangerous for those around the week before the appearance of pronounced symptoms. Therefore, if a person's pet is infected with rabies, he may not suspect this moment until the animal attack him or he does not show clinical symptoms - why increases the likelihood of infection.

The pathology forecast usually depends on the timely appeal to the doctor after the bite of cats, dogs or another animal and on the compliance with the mode of prophylactic vaccination. Those who have been identified a rabies virus in the late stage, and who did not receive in a timely manner for medical help After the incident - in 100% of cases die.

Most often, children and adolescents come to the hospital with a suspicion of the rabies virus - this is due to the fact that children are more susceptible to contacts with different animals. Adults suffer from this ailment only if the patient's attack attacks and untimely appeal to the hospital, while the child may not pay attention to a slight bite or enter the infected saliva of the carrier in the open wound on his body.

We also note that more often from such a disease, as a man's rabies suffer from residents of the countryside, as they are more susceptible to contacts with different types of animals.

The rabies virus, falling inside the body, spreads through the nervous trunks, hitting the entire CNS. After that, it is heading into salivary glands, making saliva infected dangerous to others.

The main reproduction of rabies virus is nervous fabrics. Active growth leads to the formation of ethics and degenerative-necrotic changes in the affected nerve cells, which explains the typical symptoms of rabies.

Features of symptoms

The symptoms of rabies in humans are not manifested immediately, but only after 1-3 months from the moment of infection. Sometimes the disease manifests itself and much later - in six months or even a year after the bite of cats, dogs and another sick animal, which is happening in cases where the bite is localized on the lower limbs. If the bite is localized on hand, face or body, signs of rabies can appear within a few weeks.

In medical practice distinguish 3 stages of this disease:

• the first stage is the depression stage;
• the second is the stage of psychomotor excitation;
• the third is the stage of development of paralysis.

The first signs of rabies in humans are associated with the emergence of unpleasant sensations at the bite, although the wound, which was applied, may already be fully alienated by that time. Sometimes there is a re-inflammation of the bite area - compensation and hyperemia occurs.

The patient complains of burning in the area of \u200b\u200bthe wound, the feeling of pulling pain and swelling. If the bite was located on the face, the first signs can act as visual and auditory hallucinations.

Other symptoms that cause rabies virus at the initial stage:

• subfebrile temperature;
• the emergence of inexplicable fears and the development of an apathetic state (less often the state of excitation);
• sleeping is disturbed - accompanied by frightening dreams;
• the appetite decreases, and, accordingly, the body weight is reduced.

At the stage of the first symptoms of vaccinations from rabies and treatment of the disease no longer give the necessary result. After several days of such a state, a person becomes excited and does not control itself - the disease passes to the second stage.

A characteristic symptom of the second stage of such a disease, like a man's rabies, is the development of hydrophobia. A person is pathologically afraid of water - even the need to drink causes panic attacks with the spasms of the muscles of the larynx and impaired respiratory function. One sound of flowing water can cause a panic attack and spasms, which is why the drinking mode is disruption and the body dehydration occurs.

Also in the second stage of rabies, a person is very sensitive to other stimuli. Convulsions may arise from wind blowing, from bright light and loud soundMoreover, the attack is manifested not only by convulsions, but also an uncontrolled reaction in the form of riotiness and rabies. Patients tear on themselves clothes, fight, bite and spits - thanks to this, the rabies virus applies outside the body of the carrier.

Pupils of a person are expanding, he often looks at one point, sweating increases, breathing becomes heavy and intermittent. Consciousness of a person is dimming, he is experiencing hallucinations.

Very often at the height of the attack, the heart stops and the person dies. If this did not happen, then after the end of the attack, the patient's consciousness clarifies. This stage can continue from one day to three days, after which (if a person did not die) the paralysis stage comes.

Signs of the third stage on the part seems to be improved, since convulsions and hydroboyazes are stopped, and the patient decreases motor activity and sensitive perception. In fact, this is a signal about the emergency death of a person - the temperature of his body sharply increases to 40 degrees, and a gradual paralysis of all organs and systems in the body appears. When the respiratory system is paralyzed or death comes.

Active manifestations of such a disease like rabies can last from 5 to 8 days. Sometimes the disease begins immediately from the second stage, and in children it, in general, can proceed rapidly - without pronounced symptoms with a rapid arrival of death (within 24 hours).

Diagnosis and treatment

Freshness is diagnosed based on clinical manifestations and presence of characteristic bites on certain parts of the body. Diagnostics should distinguish this pathology from other diseases, such as ,. Therefore, clinical symptoms should be considered primarily, because each disease has characteristic manifestations that cannot be confused with anything.

Treatment, first of all, is the provision of emergency assistance to a branched animal. People are placed in separate chambers, and spend symptomatic therapy, allowing them to facilitate their condition.

In large doses, the introduction of morphine, diphrolrol, aminazine to suppress the development of convulsive syndrome is shown. Also, treatment provides for the creation of favorable conditions for sick people - their chambers must be protected from sharp sounds, lights and noise of flowing water, etc. But even such treatment does not guarantee that a person does not have an attack at the peak of which he will die.

Unfortunately, despite several confirmed cases of recovery from such a disease, like rabies, in the world, scientists and doctors, and did not have an effective remedy for this ailment. Therefore, the forecast for the appearance of the first signs of the disease is unfavorable, since the treatment allows only a little to extend the life of a person, but not to cure it.

Prevention

Since the treatment does not give effect, the most important importance is given to the prevention of rabies. To this end, the vaccination from rabies to a person who was attacked. In addition, there are no compulsory people who have a professional need to work with animals - hunters, veterinarians, dogcolov.

There are specific and nonspecific rabies prevention. Specific lies in the introduction of anti-grade serum or immunoglobulin, followed by vaccination. Nonspecific is a thorough processing of a wound with 20% medical soap solution.

Features of vaccination

Since the treatment of rabies at the stage of signs is no longer effectively, to prevent the dissemination of the virus, the prevention of illness is required, by introducing a special vaccine.

Waughter vaccinations are appointed in such cases:

• if he was attacked clearly an unhealthy animal and received open damage to the skin;
• if he was hurt by the subjects, on which the saliva was infected;
• if he has scratches from contact with animals, which soon after their application died for an incomprehensible reason;
• if he underwent wild rodents bite;
• if he has been contacted with a salivary patient with such pathology as rabies, a person, and in other cases, when the alleged carrier could get into the open wound.

The grafting from rabies is not needed if the bite was applied through the clothes, which remained intact, when used by properly donated meat of animals, patients with such a disease, like rabies, and in the event that after the bite during the week, the animal did not develop signs of the disease .

Cheing vaccinations are prescribed immediately, with certain periodicity. They are carried out both outpatient and stationary - depending on the desire of the patient and the severity of bites. It should be remembered that vaccination can cause side effects, such as redness of the injection site, an increase in body temperature, dyspeptic disorders, a violation of a general condition. There are special instructions regarding vaccinations from rabies and taking alcohol - to prevent the development of post-specific complications, people are prohibited during the vaccination period and half a year after it is used to use alcoholic beverages.

North-West State Medical University named after I.I.Mechnikova

Department of Infectious Diseases

Head. Kaf.: Professor Lobzin Yu.V

Lecturer: Associate Professor Romanova E.S.

Abstract on the topic:

Rabies

Performed: Student 546 gr.lf

UHATOVA A.A.

St. Petersburg, 2014

Rabies -viral zoonotic natural source infectious disease with a contact mechanism of transmission of the pathogen through a saliva of an infected animal, characterized by a severe damage to the central nervous system.

Etiology:

The pathogen - RNA genomic virus genus Lissavirus family Rhabdoviridae. It has a stick-shaped or bullet form, contains two antigen: soluble S-AG, common to all Lisserius, and a surface V-AG, responsible for the development of antiviral immune reactions. Two variants of the virus are known: street (wild), circulating in nature among animals, and fixed, used for the manufacture of vaccines against rabies. Various on the antigenic structure, therefore vaccination with a fixed strain creates immunity to the street virus.

The firm virus in the external environment - dies when heated to 56 0 s in 15 minutes, when boiling in 2 minutes. It is sensitive to ultraviolet and direct sunlight, to ethanol and to many disinfectants. However, resistant to low temperatures, to phenol, antibiotics.

Epidemiology:

Sources and reservoir of infection - the source of rabies virus are both wild and domestic animals. Wildlinks include wolves, foxes, jackals, raccoons, badgers, skunks, bats, rodents, and to homemade dogs, cats, horses, pigs, small and cattle. However, foxes and homeless dogs outside the city in the spring-summer period are the greatest danger to a person. Transmission mechanism - Contactful, human infection usually happens when bites, less often with sick with rabies animals. last years It has been proven that besides contact with the air herogenous (in caves inhabited by bats, intraboating infesses), alimentary and transplantation paths of transmission of the virus.

Natural susceptibility of people is not universal and is largely determined by the severity of damage caused and localization of the bite.

Pathogenesis:

If the virus gets into the damaged skin, its promotion begins on the nervous trunks to the central nervous system, then centrifugal to the periphery, while the entire nervous system is defeated. Finding into salivary glands, the virus is highlighted with saliva.

If you get into the nervous fabric, the rabies virus causes swelling, necrotic and degenerative changes, nerve cell hemorrhages. The destruction of neurons in the crust occurs and in the brain bridge. In the brain, edema, hemorrhage, degenerative and necrotic changes are formed. The process captures the bark of the brain, the cerebellum, the auditorium, subbojor region, the core of the cranial nerves. Similar changes are developing in the middle brain, basal ganglia and in the brain bridge. Maximum lesions are observed in the region IV ventricle. Changes in the central nervous system are associated with convulsive contraction of respiratory and swallowing muscles, increasing the separation of saliva and sweat, respiratory and cardiovascular disorders. In the cytoplasm of brain cells, eosinophilic inclusions are found (Babesh - Negri). In the future, from the central nervous system, Viruspops in various organs and systems: skeletal muscles, heart, lungs, liver, kidneys, adrenal glands. Penetrated into salivary glands, it is distinguished with saliva.

- infectious zoonosis of viral etiology, characterized by preemptive heavy lesions of the central nervous system, threatening fatal outcome. Man is infected with rabies in the bite of animals. Spreading through nervous fibers, the rabies virus initially increases their excitability, and then causes the development of paralysis. Penetrating in the tissue of the spinal and brain virus causes gross violations in the work of the CNS, clinically manifested by various phobias, attacks of aggressive excitation, hallucinatory syndrome. Frenzy still remains an incurable disease. For this reason, it is difficult to overestimate the importance of the prophylactic anti-cancer vaccination conducted by the patient in the event of an animal bite.

MKB-10.

A82.

General

- infectious zoonosis of viral etiology, characterized by preemptive heavy lesions of the central nervous system, threatening fatal outcome. Man is infected with rabies in the bite of animals.

Characteristic pathogen

Rambey causes a RNA-containing a chandelirus, having a pulver form and having two specific antigens: soluble AGS and surface AGV &. In the process of replication, the virus contributes to the neurons of specific inclusions - eosinophilic Taurus Babez-Negri. The rabies virus is quite resistant to cooling and freezing, but is easily inactivated by boiling, exposure to ultraviolet radiation, as well as disinfection of various chemical reagents (lysol, chlorine, carboxylic acid, Sumull, etc.).

The reservoir and source of rabies are carnivorous animals (dogs, wolves, cats, some rodents, horses and cattle). Animals distinguish the virus with saliva, the contagious period begins 8-10 days before the development of clinical signs. Sick people are not a significant source of infection. The rabies are transmitted parenterally, usually during the bite of a person sick animals (saliva, containing the pathogen, falls into the rink and the virus penetrates into the vascular channel). Currently, there is data on the possibility of implementing an aerogenic, alimentary and transplacentating path of infection.

People have limited natural susceptibility to rabies, the likelihood of infection in the case of infection depends on the localization of the bite and the depth of the damage and ranges from 23% of cases in the bite of limbs (proximal departments) to 90% in case of bite in face and neck. In third cases, infection occurs when the wild animal bites are bite, in other cases the perpetrators of human defeat with rabies are pets and cattle. In case of timely treatment for medical care and conducting preventive measures in complete extent, rabies in infected persons does not develop.

Pathogenesis of rabies

The rabies virus penetrates the body through damaged skin and spreads through the fibers of nerve cells to which has a pronounced tropiness. In addition, the organism virus is possible with blood and lymph current. The main role in the pathogenesis of the disease plays the ability of the virus to associate the receptors of acetylcholine of nerve cells and increase the reflex excitability, and subsequently, to cause paralysis. Penetration of the virus in the cells of the head and spinal cord leads to rude organic and functional disorders of the CNS. Patients develop hemorrhages and brain swelling, necrosis and degeneration of its fabric.

In the pathological process, cells of the bark of the hemispheres, the cerebellum, the visual beast and the subbozhny region, as well as the core of the cranial nerves are involved. Inside the neurons of the brain with microscopy, eosinophilic education (Taurus Babeshe-Negri) are noted. Pathological rebirth of cells leads to functional disorders of organs and systems due to innervation violations. From the central nervous system, the virus applies to other organs and fabrics (lungs, kidneys, liver and gland internal secretion, etc.). His getting into the salivary glands leads to the selection of the pathogen with saliva.

Symptoms of rabies

Incubation period The rabies can be from a pair of weeks when localizing the bite on the face or neck to several months (1-3) when the pathogen is deployed in the limb area. In rare cases, the incubation period was delayed until the year.

Framing occurs with a consistent change of three periods. In the initial period (depression) there is a gradual change in the behavior of the patient. In rare cases, depression is preceded by general malaise, subfebilitation, pain in the field of infection (as a rule, already helazed to the beginning of the disease of the wound). Sometimes (extremely rare) the place of deployment of the causative agent is again inflamed. Usually in this period of the clinic is limited by manifestations from the central nervous system (headaches, sleep disorders, loss of appetite) and psyche (apathy, depression, irritability, depression and fear attacks). Sometimes patients can feel discomfort in the chest (constraint), suffering from digestion disorder (usually constipation).

The midst of the disease (stage of excitation) comes 2-3 days after the appearance of the first signs of depression, is characterized by the development of various phobias: fear of water, air, sounds and light. Hydrophobia - fear of water - interferes with patients with drinking. Characteristic behavior - when stretching a glass with water, a patient with joy takes it, but an attempt to drink a liquid causes an attack of a paralysis fear, the suspension of breathing and the patient throws a glass. However, rabies are not always accompanied by hydrophobia, which may make it difficult to diagnose. During the progression of the disease, patients suffer from severe thirst, but in view of the reflex formed, even the appearance and noise of water causes spasms of respiratory muscles.

Aerofobia is characterized by the attacks of suffocation due to air movement, with acoustofobia and photophobia, such a reaction is observed on noise and bright light. The attacks of suffocation are short-lived (a few seconds), they are accompanied by spasms and convulsions of the mimic muscles, pupils are expanded, patients are excited, experiencing panic horror, screaming, lean their heads back. There is a trembling of hands. Breathing during paroxysms intermittent, whistling, incho - noisy. In respiration, the muscles of the shoulder belt is involved. In this period, patients are in an aggressive excited state, much shout, prone to unsystematic aggressive activity (mood, can hit or bite). Characterized hypersalization.

With the progression of the disease, excitation attacks are becoming increasingly. There is a loss of weight, excessive sweating, hallucinations arise (auditory, visual and olfactory). The duration of the excitation period is 2-3 days, less often extends to 6 days.

The terminal stage of the disease is paralytic. At that time, patients become apatical, their movements are limited, the sensitivity is reduced. Due to the sacrament of phobic paroxysms, there is a false impression that the patient has become better, but at this time the body temperature quickly rises, tachycardia and arterial hypotension develops, paralysis of the limbs arise, and in the future and cranky brain nerves. The defeat of the respiratory and vessels center causes a stopping of cardiac activity and respiration and death. The paralytic period can last from one to three days.

Diagnosis of rabies

There are methods for allocating rabies virus from liquor and saliva, in addition, it is possible to diagnose with the reaction of fluorescent antibodies on dermis biopsies, cornea prints. But in view of the laboriousness and economic inappropreciation, these techniques do not apply in wide clinical practice.

Basically, the diagnosis is carried out on the basis of a clinical picture and data of epidemiological history. TO diagnostic methodshaving a lifestyle, also include a biocrust on laboratory animals (newborn mice). When infected with them selected from saliva, liquor or tear fluid, the mice die in 6-7 days. Histological analysis of the brain tissue of the deceased patient allows you to finally confirm the diagnosis in the case of detecting in cells Taurus Babez-Negri.

Treatment of rabies

Currently, rabies is an incurable disease, therapeutic measures are palliative and are aimed at facilitating the patient's condition. Patients are hospitalized into a darkened insulated ward, they are prescribed symptomatic agents: sleeping pills and anticonvulsants, painkillers, tranquilizers. Food and rehydration measures are carried out parenterally.

Now there is an active testing of new treatment regimens with specific immunoglobulins, immunomodulators, brain hypothermia and intensive therapy techniques. However, so far rabies is a fatal disease: a fatal outcome occurs in 100% of the development of clinical symptoms.

Prevention of rabies

The prevention of rabies is primarily aimed at reducing the incidence among animals and limiting the probability of bite by stray and wild animals of man. Pets are mandatory subjected to planned vaccination against rabies, decreated categories of citizens (employees of veterinary services, dogcolovy, hunters, etc.) undergo immunization of anti-cancer vaccine (triple intramuscular administration). A year later, revaccination and in the future in the event of the preservation of high risk of infection, the repetition of immunization is recommended every three years.

In the event of an animal bite, a set of measures aimed at preventing rabies are being made: the wound is washed with medical alcohol, processed by antiseptics, an aseptic bandage is superimposed, after which it is necessary to immediately contact the trauma art (or to a surgeon or Feldester FAP). In the shortest possible time, a course of prophylactic anti-flame vaccination (dry inactivated vaccine) and passive immunization (anti-igrabic immunoglobulin) is carried out. The scheme of prophylactic injections depends on the localization of the bite, the depth of the wound and the degree of pollution of saliva.