醫(yī)學英語課件資料：狂犬病

1、RabiesRole CliniciansFramework-Based LearningINTRODUCTIONYundi PanIntroduction to rabiesViral diseaseThe central nervous system MammalsAbnormal behaviorBiteDOGBATRACOONThe etiological agentsClassificationThe Rhabdoviridae familyThe Lyssavirus genusDifferent species 147Rabies virusSpeciesHuman casesR

2、abies virusMajorityAustralian bat lyssavirus2European bat lyssavirus, type 1Tiny minorityEuropean bat lyssavirus, type 22Irkut virus1Duvenhage3Mokola virus2Data: World Health Organization, WHO expert consultation on rabies : Second report, 2014Table 1. Human-related lyssavirusesStructureFigures: /ra

3、bies/transmission/virus.html. Accession date: 16 Oct 2016Single-stranded RNABullet-shapedEnvelopeSpike-like peplomersRibonucleocapsidReplicationFigure: Mietzner et al, Jawetz, Melnick, & Adelbergs Medical Microbiology (27th): Figure 42-2. Attachment Nicotinic acetylcholine receptorPenetrationRelease

4、TranscriptionIncorporationBuddingThrough wounds or mucosal surfacesReplicationSpread peripheral nerves central nervous system brain salivary glands and other tissuesPathogenesisFigure: http:/buletin-disease-xv-rabies. Accession date: 16 Oct 2016Susceptibility Incubation period Host age, genetic back

5、ground, immune statusVirus strain, amount of inoculumEntry point severity, degree of innervation, distance EpidemiologyDistribution of risk levels of human contacting rabies, world wide, 2013Figure: /rabies/Global_distribution_risk_humans_contracting_rabies_2013.png?ua=1. Accession date: 16 Oct 2016

6、Manifestations&Diagnosis Zhen ZhangClinical Manifestations?Picture: /detail/22650/Clinical ManifestationsProdromal symptoms usually unsuspected Clinical rabies encephalitic rabies & paralytic rabiesProdromal SymptomsUnsuspected low-grade fever, chills, weakness, sore throat, etc.paresthesias radiati

7、ng proximally from the site of a known woundPicture: /chengzhang/etq/jb/2012/1026/295022.html/Clinical RabiesEncephalitic rabies (80%)HydrophobiaAerophobiaAutonomicCombativenessPic from wechat Clinical RabiesParalytic rabies(20%) most prominent in the bitten limb and spreads physical examination not

8、able for fasciculations headache and pain in the affected muscles with mild sensory disturbance DiagnosisClinical diagnosis thorough patient history and a high index of suspicion paresthesias surrounding the animal bite virus-specific immunofluorescent staining before deathDiagnosisLaboratory diagno

9、sisTests combination saliva skin serum CSFDifferential DiagnosisWith signs of encephalitisOther more common infections(eg. herpes simplex virus) and other noninfectious disorders(eg.central nerves system vasculitis)Distinguished by the presence of hydrophobia, aerophobia, dysphabia and localized pai

10、n.With signs of paralysisNo sensory disturbances and fever in the onset of paralysisOther acute neuromuscular junction disorders affecting the spinal cordTreatment of rabiesNOeffective therapySupportive therapy Palliative!Vaccine/s/ProphylaxisPing XuProphylaxisExposure TypePre-exposure ProphylaxisPo

11、st-exposure ProphylaxisExposure TypeBitesBat exposureNon-bite animal Human-to-human transmissionExposure Type-BitesThe risk of acquisition increasesMultiple bitesIn closer proximity to the CNSExposure Type-BatRabies virus variants Imperceptible biteAwait if is capturedExposure Type-Non-bite animal e

12、xposuresExtremely rareTwo general conditionsMucous membranes or open woundsAnimal fluid/tissueExposure Type-Human-to-human transmissionBiteNon-bite exposuresTransplantation Pre-exposure ProphylaxisInapparent exposuresLaboratory workersGownsMasksGlovesEye/face protectionAfford some protectionPost-exp

13、osure Prophylaxisdomestic animal rabiesDogs 90%Cats 5%BatsUnited States Wild terrestrial mammalscarnivoresPost-exposure Prophylaxisdomestic animal rabiesDogs 90%Cats 5%BatsUnited States Wild terrestrial mammalscarnivoresPost-exposure Prophylaxisdomestic animal rabiesDogs 90%Cats 5%BatsUnited States

14、Wild terrestrial mammalscarnivoresPost-exposure Prophylaxisdomestic animal rabiesDogs 90%Cats 5%BatsUnited States Wild terrestrial mammalscarnivoresPost-exposure ProphylaxisCategory 1: licks on intact skinCategory 2: nibbling of uncovered skin scratches or abrasions Category 3：transdermal bites，lick

15、s on broken skin，contamination with saliva, batsPost-exposure ProphylaxisCategory 1: licks on intact skinCategory 2: nibbling of uncovered skin scratches or abrasions Category 3：transdermal bites，licks on broken skin，contamination with saliva, batsPost-exposure ProphylaxisCategory 1: licks on intact

16、 skinCategory 2: nibbling of uncovered skin scratches or abrasions Category 3：transdermal bites，licks on broken skin，contamination with saliva, batsRIG & VaccineYanying Wang Preparations for ProphylaxisRabies immune globulin (RIG)“Passive immunization”Rabies vaccine“Active immunization” RIGHuman RIG

17、 (HRIG) vs. Equine RIG (ERIG)No transmission of infectious agents HRIG recommendedImmediate virus-neutralizing antibodiesShort half-lifeHRIG: 3 weeks Rabies VaccineProtective virus-neutralizing antibodiesProduction: within 7 to 10 daysPersistence: several yearsTwo main licensed vaccinesHuman diploid

18、 cell vaccine (HDCV)Purified chick embryo cell vaccine (PCECV)Safety of Rabies BiologicsHRIGLocal reactions: pain, tenderness, erythema and indurationHeadacheSafety of Rabies BiologicsHDCVLocal reactions: Pain, redness, swelling and induration Common and mild Systemic reactions: Mild fever, headache

19、, dizziness and gastrointestinal symptoms Less common Neurologic adverse events: rareSafety of Rabies BiologicsPCECVLocal reactions Mild side effects: Headache, fever, myalgia, nausea and weaknessSerious adverse events: uncommon What to Administer Preexposure prophylaxisVaccine alonePostexposure prophylaxisUnimmunized persons: both passive and active immunizationReason Exposed persons who hav