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POV: A Raccoon Bit Your Child

What is rabies? How do you identify it, and once it’s started, can you be saved?

The oldest records of rabies date back to 2300 BC, with early treatment involving holding the infected underwater, or consuming calcified hairballs. Notably, famed writer Edgar Allen Poe was suspected to have died of a rabies infection.

Although modern medicine has come a long way (no you do not have to eat a hairball), many aspects of the rabies virus are still a mystery, and treatment is only effective before the virus infects the central nervous system (CNS). In the case of rabies, prevention is key.

Pathogenesis

Rabies, a lyssavirus, can only be spread by bites or scratches from an infected mammal. Lyssaviruses fall under the Rhabdoviridae family, typically rod/bullet-shaped, enveloped, containing single-stranded negative-sense RNA. The pathogenic sequence is as follows:

Virus enters the body (through a wound, or direct contact of infectious material with mucous membrane)
Virus replication within host cells then travels to the CNS; OR travels to the CNS before replicating
Spread throughout the body

The rabies virus is suggested to travel within the nervous system by hitchhiking on axonal vesicle transport and spreading between synapses. The general process of infection first targets the CNS (brain), before spreading to peripheral organs via the peripheral and autonomic nervous system.

Symptoms

Specific symptoms of an infection by the rabies virus can fall under two categories:

Furious Rabies
1. Hyperactive, excitable state
2. Hallucinations
3. Dysphagia (difficulty swallowing)
  1. Note: the hydrophobia (fear of water) commonly associated with rabies is due to the infection causing spasms in the throat, leading to difficulty swallowing
Paralytic Rabies
1. Gradual muscle paralysis
2. Comatose state

Other generic signs of infection such as fever, pain, and prickling or burning sensations at the site of the wound precede specific symptoms.

High Risk Demographics

According to the World Health Organisation, the rabies virus causes an estimated 59 thousand deaths each year, with the majority being children afflicted. This may be attributed to the variable incubation period of the virus, ranging from 1 week to a year – people bitten by rabid animals may seek medical treatment right away, but someone with an open wound may not notice if they were to come into contact with infectious material.

Those in occupations or participating in personal activities that increase the likelihood of exposure to an infected animal (i.e. wildlife rangers, laboratory workers handling the rabies virus) are recommended to take Pre-exposure Prophylaxis.

Treatment

Despite existing vaccines, once an infected person starts displaying symptoms, death is inevitable. Should exposure to the rabies virus be suspected, immediately carry out extensive wound washing for at least 15 minutes, and seek medical attention. Post-exposure Prophylaxis can be administered, and treatment courses depend on the extent of exposure and prior immunization history.