The Rage It is a viral infectious disease that has been recognized for millennia for its rapid evolution and incredible clinical manifestations. It is transmitted by warm-blooded mammalian animal vectors such as: bats, dogs, cats, raccoons, skunks and even humans.
The Rabies virus belongs to the genus of Lyssaviruses of the Rhabdoviridae group and its structure is formed by bullet-shaped RNA that it is transmitted in 90% by means of the bite of a vector animal (which may be only a carrier of the virus) through saliva.
A characteristic way and uncommon transmission is through inhalation of the virus, which occurs when the patient is in areas with many concentrated bats.
- 1 Rage: The development of the disease
- 2 Phases of rabies disease
- 3 Rabies treatment
- 4 Final Comments
Rabies: The development of the disease
The development of the disease begins with the virus inoculation, which enters through the intramuscular bite.
The virus begins to replicate locally until it reaches a neuromuscular junction, where the nervous system infection will begin by binding to acetylcholine receptors.
Once here, the virus travels through the afferent (sensory) peripheral nerves upstream in a centrifugal way.
It travels until it reaches the spinal cord and finally ascends until it reaches the brain. When the infection reaches the brain neurons, clinical symptoms begin to appear in the patient.
By last, the infection ends when it begins to spread through sensitive nerves from the Central Nervous System (CNS) to other tissues of the Autonomous Nervous System (ANS): Salivary glands, heart, skin and adrenal glands.
Commonly the incubation period of rabies is between 20 to 90 days from the exhibition but it can also be from a few days to more than a year. This variability is due to the fact that It depends on the amount of virus inoculated and the speed of replication of the virus until reaching the CNS.
Phases of rabies disease
The clinical picture It consists of 3 characteristic phases
- The prodromal phase
- Neurological phase
- Finally, the state of eat
The prodromal phase
The prodromal phase lasts from 2 to 10 days and it is the beginning of the clinical stage with the gradual appearance of the general symptoms of the infection.
It is relatively unspecific and among its signs are: fever, headache, malaise, nausea and vomiting.
In most cases, neurological symptoms appear: paresthesia, pain or pruritus in the area of infection (pathognomic signs of the pathology). Consciousness is maintained with some anxiety / agitation presence.
The neurological phase
The neurological phase lasts 2 to 7 more days and is composed of two variations: Encephalitic rabies (80% of cases) and paralytic rabies (20% of cases).
- Encephalitic rage, also known as the excitatory stage, presents: accelerated pulse, aggressiveness, hallucinations, increased activity of the ANS: priapism, piloerection, hypersialorrhea (increased salivary secretion, "foam"), etc.
- There are lucid lapses and seizures, these lapses are getting shorter and shorter.. Brain stem failures cause a characteristic sign of this type of rage: hydrophobia and aerophobia, because there are painful and involuntary spasms of all swallowing / breathing muscles that cause the patient to refusal to drink water for fear of suffering the consequences.
- The patient can become very aggressive, with swollen, reddish eyes and hypersialorrhea, offering a fearsome image. If in one of the episodes of aggressiveness it bites others, it can transmit the disease.
- Paralytic rage is less drastic than brain rage, but it can last longer. It is more associated by transmission by bats than by dogs. The spinal cord is more affected than the brain, therefore, there are different symptoms. The manifestations consist of muscular weakness plus gradual and ascending paralysis of skeletal muscles until reaching the heart muscle and death.
Finally, the nervous system condition is so important that the infected person enters into a coma and dies, in many cases, after a terrible agony, as is the case in the case of brain rage.
Treatment begins with prophylaxisThis is of the utmost importance since it is believed that proper wound hygiene can prevent the development of pathology by 90%.
The wound should be washed with soap and water, alcohol and benzalkonium chloride. Finally, we proceed to vaccinate the patient with human diploid cell (HDCV) vaccines containing the inactive virus with beta propriolactone.
Currently, it is the one that causes the least side and allergenic reactions. Administration is given in 6 doses on days 0, 3, 7, 14, 30 and 90 after exposure.
Half of the dose is administered at the site of the wound and the other half is intramuscularly (by slow release). Fortunately, if there is the correct prevention, control and treatment of the disease, they have a very favorable prognosis.
The main importance of knowing this disease is that, despite not being so common in developed countries, It should be taken into account when there has been contact with any animal of doubtful origin since if a preventive treatment against rabies is not provided from the beginning of the exposure, it is very difficult to combat it.
Once the infection shows manifestations it is because the CNS is infected. When this happens there is nothing left to do, the patient dies within 15 days more or less.
Peña-Herrera, B. and Marcial, P. (2018) Neurosciences: Etiology of brain damage. Samborondón: Espiritu Santo University - Ecuador.