- Rabies: description
- Rabies: symptoms and disease course
- Rabies: causes and risk factors
- Rabies: examinations and diagnosis
- Rabies: Treatment
- Rabies: Disease course and prognosis
rabies is a viral disease that is transmitted to humans mostly through the bite of mammals such as dogs and foxes. Subsequent vaccination can prevent the pathogen from migrating to the brain. If the disease has already broken out, it is deadly. The number of deaths from rabies worldwide is estimated at about 55,000 per year.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. Z24A82
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Rabies is a viral infection of the central nervous system. Other names for the disease are rage disease, Lyssa (Greek), Rabies (Latin / English) and Rage (French). The causative agents of the disease are lyssaviruses. The incubation period - ie the time from infection to the onset of the disease - is generally three to eight weeks, but may be less than nine days in rare cases. Once the disease has broken out, it is almost always fatal. Immediately after infection, however, immunization may still prevent the onset of the disease.
Transmission by saliva
Rabies is almost always transmitted by infected animals. If an animal has become infected with the viruses, they initially multiply in the central nervous system and then scatter. Among other things, the viruses are expelled in bulk in saliva. Transmission to humans usually occurs through the bite of an infected animal. However, infection is also possible through skin injury, or when infectious material such as saliva comes into direct contact with the mucous membrane.
Wild animals that have become infected with rabies often lose their fear of humans (for example, foxes). If a wild animal behaves unusually, you should therefore pay particular attention and go at a distance. Even those who find a lying on the floor bat and wants to help, should at least wear leather gloves. Anyone who is bitten anyway, must see a doctor immediately!
Germany is considered rabies free
Germany has been considered free of the classic wild rabies since 2008. This is achieved by the immunization of wild animals by feed baits, especially foxes. There were also regular rabies vaccines from pets. The last case of rabies in a wild animal - a fox - was registered in February 2006. Many other European countries such as Switzerland, France, Belgium, Luxembourg, the Scandinavian countries, the Czech Republic, Spain and Portugal, Great Britain and Ireland are officially "rabies-free".
The last reservoirs of the pathogens in this country are bats. They carry a different form of Lyssaviruses than foxes, but are closely related to the Fuchserreger. Doctors assume that the bat rabies is as dangerous for humans as the classic wild rabies.
Recent rabies cases among people in Germany
In 2005, a woman was removed from organs for transplantation, which had previously been infected with rabies in India. Of the total of six organ recipients, three died and died as a result of rabies. The recipients of the two corneas did not become ill, as did the recipient of the liver, who had previously been vaccinated against rabies.
Most recently, rabies was diagnosed in Germany in 2007 by a man who had become infected during a stay abroad in Morocco by a dog bite.
For people living in Germany today only an increased risk of infection exists when traveling to countries where rabies still occurs. However, disease transmission by bats can not be ruled out in Germany.
Rabies: symptoms and disease course
The rabies incubation period (time from infection to the onset of the disease) is usually three to eight weeks. Occasionally, however, it can take several years. Rarely, the incubation period is shorter than nine days. The closer the portal of entry of the rabies virus is to the brain, the shorter the incubation period. Because the viruses move from the point of entry along the nerves towards the brain. Once they have arrived there, it comes to the onset of the disease. It then runs deadly.
Three stages of rabies
Rabies runs in three stages in humans:
prodromal: In the first stage of rabies, there are unspecific symptoms such as headache, nausea, vomiting, abdominal pain, diarrhea, usually also fever and possibly coughing. The bite tingles and itches. In the further course, the patients become irritable and sensitive to light, noise and breeze. The fever is constantly increasing.
Acute neurological phase (excitation stage): The so-called encephalitic form of a rabies infection manifests itself mainly in the brain. The patients develop a pronounced fear of water (hydrophobicity). Swallowing causes the muscles of the pharynx to cramp, causing patients to be afraid of swallowing. The patients even avoid swallowing their own saliva so that it flows out of their mouths. Already the sight of water or drops and noise trigger restlessness and convulsions. The state of mind of patients varies between aggression and depression.
The rarer paralytic form of rabies mainly affects the nerves of the spinal cord and the peripheral nerves. Increasing paralysis occurs especially at this stage.
Coma (paralysis stage): In the last stage of rabies, the patient suffers from progressive signs of paralysis. The patient eventually falls into a coma and usually dies from respiratory paralysis. Once rabies breaks out, it ends fatally.
Rabies: causes and risk factors
The causative agent of rabies is the rabies virus (Lyssavirus). In industrialized countries, the virus is found mainly in forest animals; these transmit the rabies pathogen to pets and humans. In Africa, Asia and Latin America, however, dogs are the main carriers and responsible for most deaths from rabies worldwide.
The most common form of transmission of rabies to humans are bites or scratch injuries of infected dogs, cats, foxes, raccoons, skunks, jackals and wolves, as well as insectivores (eg, hedgehogs) and vampire bats. Although cattle, horses, small game and other herbivores can become infected, they rarely occur as transmitters of rabies to humans.
Even with simple contact, for example, when stroking infected animals, you can be infected - but the risk of infection is very low here. Most viruses are in saliva. Especially when it comes in contact with mucous membranes or wounds, there is a very high risk of rabies infection.
Rabies is considered extinct in Germany. Suffering from bats, it still occurs. But since native species are not vampire bats, but mainly feed on insects, they do not attract humans. A risk of becoming infected exists only in direct contact with the bats - or traveling to countries where there are still many rabies animals.
Rabies: examinations and diagnosis
The suspicion of rabies in humans is always given in every contact with a potentially infected animal - especially in bite and scratch injuries. A stronger suspicion arises when already corresponding clinical symptoms occur.
For a precise diagnosis, the genetic material - the RNA - of the rabies pathogen (Lyssavirus) is detected in the saliva, in the cornea of the eye or in the brain fluid. However, it is not always possible to diagnose a rabies infection in this way. A safe, clear diagnosis of rabies is often possible only after the death of the person affected.
A rabies vaccination must be carried out on suspicion of contact with a rabid animal. In the case of an infection, she is the only chance of salvation.
After an animal bite or other contact with a potentially infected animal, you must rinse and clean the bite or pads as quickly as possible with water, soap or detergent solution. You should also disinfect them with alcohol or iodine solutions.
Afterwards, after an animal bite, you must always consult a doctor who will administer a suitable vaccine. Even with light scratches or after a conspicuous or wild animal has licked your skin, the rabies vaccination must be done as soon as possible.
The doctor administers ready-made antibodies (immunoglobulins) that fight the rabies virus in the body (passive immunization). In addition, the patient receives an active vaccine that contains killed virus components and a self-protection of the body against the virus incites, thus stimulating the formation of specific antibodies against the virus.
If the first symptoms of rabies already appear, a vaccine or the administration of the antiserum is no longer effective. The treatment of rabies then consists exclusively in the relief of symptoms such as convulsions or respiratory paralysis. There are rarely more than seven days between the onset of the first rabies symptoms and the fatal outcome.
Rabies - vaccination
What you need to look out for in a vaccine against rabies, see the article Rabies - vaccination.
Rabies: What you can do yourself
Before traveling abroad, you should inform yourself if rabies occurs at your destination. If this is the case, a preventive rabies vaccine may be recommended. In particular, in regions outside the usual tourist centers is a subsequent passive vaccination sometimes not be raised quickly enough. Therefore, consult with a tropical health professional about how best to protect yourself.
Rabies is very contagious.Even a bite through clothing, a slight scratch or contact with contaminated saliva can cause a fatal infection.
Wild animals are usually shy. If an animal is unusually friendly, stay away from it.
After contact with a rabies-suspicious animal, you must thoroughly clean the affected skin with soap and water and, if possible, disinfect it. This also applies if you have touched an animal that may have died of rabies. In any case, see a doctor!
If you have found the carcass of a potentially rabies infected animal, have it checked by a forester.
Rabies: Disease course and prognosis
If an infected person is not vaccinated against rabies, the prognosis depends on whether and how fast he then gets an active immune protection. That's why you need to see a doctor as soon as possible if you're in contact with a potentially infected animal.
The earlier the subsequent vaccination with antibodies, the better the prognosis. If the virus has already lodged in the brain and the first symptoms of the disease appear, it can no longer help. As a rule, between the occurrence of the first symptoms of the rabies and death for a maximum of seven days. In that case, the patient dies of respiratory or cardiac palsy.