Rabies: The Daily PANCE Blueprint
A 42-year-old male is bitten by a stray dog while traveling. He is not vaccinated against rabies. The dog cannot be found. Which of the following is the most appropriate management?
A. Observe the patient for 10 days
B. Test the patient’s saliva
C. Start rabies vaccine and rabies immunoglobulin
D. Wait for symptoms to appear
E. Reassure and discharge
Answer and topic summary
The answer is C. Start rabies vaccine and rabies 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. 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 ⇒ ⇒
