1、HydrophobiaMenuBrief introduction& PathologyDiagnosisProphylaxis&TreatmentHydrophobiaBrief introductionPathology Brief introductionHydrophobia/ nervous sysInfect by the virus carrier/ animals/ dogs wolfs batsWorld wide disease/ 100% dead ratesBrief introductionRabies virus 彈狀病毒科(Rhabdoviridae)狂犬病毒屬(

2、Lyssavirus)Bullet shapessnRNADifferent antigensOut membrane antigenCore protein antigen1884, French Louis PasteurRabies virusCenter nuclear protein (N)ssnRNABody Protein LProtein PGlycoprotein G(immune response/cell binding)Basic protein MPath of virusInfection Protein GPinocytosisRNPPath of virusTr

3、anscriptionL proteinLeader RNAN proteinReplicatonPath of virusAssemblyM proteinM-RNP complexPathogenic process3 PROCESSIdiophaseNeuron fiber of wound, 2 weeks or longerAggression of central nerve systemSpine/EncephalonAggression to other organsperipheral nervous system (PNS)SYMPTOMDiagnosisBy 楊慧華sym

4、ptomsfurious rabies(狂躁型) 1. incubation period typically 13 months days to years 2. prodromalperiod fever、headache 、 “flu”； pain or strange sensation at the wound site 3. excitationperiod hyperactivity, spasm, excited behavior, hydrophobia, photophobia and （ aerophobia）4.paralysis period flaccid para

5、lysis, coma, cardiorespiratory arrestParalytic rabies（麻痹型） 1. incubation period 2. Diseased Period high fever, dystaxia, muscles paralysis, coma, ect. no hydrophobia！Differential diagnosisViral encephalitis cerebral pia mater diffuse inflammation syndromeTetanus spasmPoliomyelitis, acute spinal cord

6、 damageJakob-Creutzfeldt disease CNS damage PseudorabiesGuillain-Barr syndrome PNS damageDetection Direct fluorescent antibody test saliva, Nasopharyngeal lotion, urine precipitate, cornea printing Rabies rapid enzyme immune diagnosis cerebrospinal fluid, cerebral tissue, saliva reversetranscription

7、alPCRVirus isolationHistologic examination biopsy or autopsy tissuesImmunohistochemistry (IHC)Electron microscopyHydrophobiaProphylaxisTreatmentpxcProphylaxis for HydrophobiaTo deal with pets:Regularly vaccinate pets such as dogs and catsKeep pets under direct supervisionIf pets are injured by wild

8、or stray animals, take them to veterinarian immediatelyTo deal with wild and stray animals:Do not handle wild and stray animals yourself, call animal control for helpKeep away from wild and stray animals which behave abnormallyProphylaxis for HydrophobiaProphylaxis for HydrophobiaTo deal with childr

9、en:Adults should tell their children not to play with animals such as dogsAdults should take care of their children to reduce the risk of being injured by animalsProphylaxis for HydrophobiaFor government and public health department:Publicities of harm and prevention of hydrophobia are importantKill

10、 animals infected with hydrophobia immediately and handle their corpses properlyEnhance work of immunity in rural areaTreatment for hydrophobiaAfter morbidity, the mortality rate of people infected with hydrophobia isAlmost 100%!Treatment for hydrophobiaAfter being bitten by infected animals:Wash th

11、e wounds immediately for 10 to 15 minutes with soap and waterPovidone-iodine or alcohol is then recommendedGo for treatment within 10 days of infectionPay attention to the risk of being infected by tetanusVaccinations: The most effective treatment for hydrophobia Rabies post-exposure vaccinations co

12、nsists of a dose of human rabies immune globulin(HRIG) Four doses of rabies vaccine given on the day of the exposure, and then again on days 3, 7, and 14 Patients who have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations on days 0 an

13、d 3Treatment for hydrophobiaTreatment for hydrophobia For people who have never been vaccinated against rabies previously, post-exposure anti-rabies vaccination should always include administration of both passive antibody and vaccine. People who have been previously vaccinated or are receiving pre-

14、exposure vaccination for rabies should receive only vaccine. Intramuscular vaccination should be given into the deltoid, not gluteal area Adverse reactions to rabies vaccine and immune globulin are not common.TransmissionTwo epizootic formsUrban form: unimmunized dogs or catsSylvatic form: skunks, f

15、oxes, wolves, raccoons, and batsExposureBroken skin: biteMucous membranes: saliva, CNS tissueAerosols: bat cavesHuman-to-human: very rareCorneal transplantsOrgan transplantsLyssavirus genusEpidemiologyEpidemiologyGlobal: 59,000 every year (underestimated)Developing countries: 99%Aisa: 60%India: 35%C

16、hina: 10%Africa: 36%Developed countries515 years old: 50%Human deathDog vaccinationDeveloping countries (Asia &Africa)Low vaccination rate of dogsHigh morbidity and mortality99% infection from dogse.g. Chinae.g. USADeveloped countries (Europe & North America)High vaccination rate of dogsRare morbidity and mortalityMain infection from wild animalsImported casesOrgan transplantation cases Total 34 confirmed cases form 2003 to 2013Im oral vaccinated.Im the only healthyvirus-carriers.Im the most frequently r