Rabies: The Daily PANCE Blueprint
A 5-year-old boy is brought to the ER by his mom. She is concerned that he was bitten by a bat earlier. She had found him in his bed crying as a bat was flying out of the open window. Vital signs are stable. On exam, you see no visible bite marks. Which of the following is the most appropriate next step in the management of this patient?
A. Administer rabies immunoglobulin
B. Reassurance and supportive care
C. Give rabies vaccine and immunoglobulin
D. Order RT-PCR for rabies RNA
E. Give empiric antibiotics and steroids
Answer and topic summary
The answer is C. Give rabies vaccine and immunoglobulin
Rabies is a type of neurotropic virus. It is contracted from the bite of an infected animal (e.g., dogs, bats, raccoons, skunks, foxes) and spreads through the saliva. The most common animal reservoir worldwide is dogs. There is an incubation period of 4-12 weeks, and then patients will start to show clinical features: flu-like symptoms, fevers, hypersalivation, hydrophobia, seizures, confusion, mania alternating with stupor, etc. 4 specimens are needed for testing (serum, saliva, CSF, and skin). Treatment is post-exposure prophylaxis (e.g., rabies vaccine given IM on days 0, 3, 7, and 14 plus the rabies immunoglobulin given into the wound site), wound care/debridement, and antibiotics. PEP is indicated in ALL non-immunized individuals after there is potential exposure to rabies with any possibility of contact. Once signs/symptoms of rabies appear, the mortality rate is 100%.
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Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ ⇒
