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Rabies

How did rabies get its name?

Dan Glickman Research Paper Rabies Ms. Mason 11/26/13

The term rabies originates from the Latin word rabere meaning to rage or to rave; rabies is most often associated with dogs that appear to be angry or in a rage. Different terms pertaining to rabies are the Sanskrit term, rabhas meaning to do violence, the Greeks term lyssa or lytta meaning a frenzy or madness. Rabies cases in humans are categorized as hydrophobic, meaning the fear of water, a common symptom shown by rabies victims.

Figure 1: An image of the bacteria that causes rabies What is rabies? Rabies is a disease caused by the bullet-shaped bacteria named Lyssavirus rabies virus (Johnson, 2013). An image of the virus can be seen in Figure 1. Rabies, an infectious virus, has been known to known in cases as early as 2300 BC (Scholand, 2003). Rabies is classified as a zoonotic disease meaning it is passed to a

human through an animal (Scholand, 2003). The first cases began as dog owners in the Babylonian city of Eshnunna were fined for the deaths of humans by the bite of a dog (Scholand 2003). In 500 BC-100 AD philosophers like Democritus, a Greek philosopher, and Aristotle wrote of the widespread infections of rabies throughout the Roman Empire, Greece, and Crete. In 1881-1885 Louis Pasteur and Emile Roux begin the research for a rabies vaccine. As seen in Figure 2, Louis Pasteur was the first man to create a successful vaccine against rabies. The first successful case of rabies, Joseph Meister, was given the vaccine in 1885 (Scholand, 2003).

Figure 2: Louis Pasteur created the first successful vaccine to rabies in 1885

How is rabies caused and what are the symptoms? Rabies is most usually caused through contact with the saliva or brain tissue of an infected animal (dog, bat, cow, etc.). Most common cases are caused through

the bite of a rabid animal most often a dog or other canine animal. Figure 3 shows a rabid bat, and bats are the most common way for residents of the United States and Canada to get rabies. However, in developing countries most people contract rabies from a rabid canine animals bite (Clinic Staff, 2011).

Figure 3: Rabid bats are most common in North America There are many symptoms of rabies, and yet early stages of the virus are often confused with that of flu. Common symptoms at this stage are general weakness or discomfort, fever, and/or headache and may last for several days. There is also an accompaniment of prickling or itching at the wound, progressing with cerebral dysfunction (brain damage), anxiety, confusion, agitation, along with more serious cases, which are characterized by delirium (illusions because of brain damage), abnormal behavior, hallucinations, and insomnia. The acute period of the virus (time of common symptoms) ends after 2-10 days, and once clinical signs of rabies appear, the disease is almost always fatal (CDC, 2013).

How does rabies affect the body? The Lyssavirus rabies virus, shaped like a bullet enters the body and makes its way to the spinal cord. Once in the spinal cord, the virus shoots up to the brain, where it begins to replicate inside the brains nerve cells, destroying them in the process. After reaching the brain, the virus travels through the nerves to the salivary glands, which causes salivation (foaming at the mouth). The virus does this as its principle method of transmission into a new host (s). There are two main physical variations of rabies. The more common of the two is the encephalitic also known as furious form of rabies. This is the mad dog, foaming at mouth, aggressive, disorientated kind, which most people think of as rabies. However, the less common form, the paralytic form is more peaceful, lethargic, and weary, but both forms are no less deadly than the other (Udow, Marrie, Jackson, 2009).

Figure 4: Rabies throughout the world in 2007

Many cases throughout the U.S. have shown that rabies is often mistaken for other diseases and usually are discovered too late to treat effectively. One example occurred on September 20, 2000: On September 15, a 49-year-old man visited a neurologist with 2 days of increasing right arm pain and paresthesias (pins and needles). The neurologist diagnosed atypical neuropathy. The symptoms increased and were accompanied by hand spasms and sweating on the right side of the face and trunk. The patient was discharged twice from an emergency department but symptoms worsened. After developing dysphagia (difficulty in swallowing), hyper salivation, agitation, and generalized muscle twitching, the patient was admitted to a local hospital on September 16. Vital signs and blood tests were normal, but within hours he became confused. The consulting neurologist suspected rabies. Rabies immune globulin, vaccine, and acyclovir were administered. On September 17, the patient was placed on mechanical ventilation and rabies tests returned positive. Renal failure developed and the patient died on September 20. The patient did not report contact with a bat, although his wife reported that in June or July a bat had flown into their house and the patient had removed it (Fossan, 2000). Reported by: D Van Fossan, MD, Sutter Amador Hospital

Figure 5 and 6: Statistics of deaths by rabies in Africa and Asia

How does rabies affect people on a world scale? Annually, around 55,000 people die from rabies each year around the world. Almost all cases of rabies are found in Africa, Asia, and the Middle East because of the lack of public awareness about rabies and responsible pet ownership, high expense of rabies PEP (treatment for rabies), and poor access to medical care. Figure 4 shows the density of rabies cases on the world scale, but does not represent the fact that most developing countries in the world do not have adequate access to the vaccine. Rabies is a 100% preventable disease however, over 3 billion people in Asia in Africa, are most at risk to the disease where human vaccines are not readily

accessible or available in rural areas. A majority of the deaths by rabies, as shown in Figures 5 and 6, occur in Asia and Africa where Asia has the most percentage of rabies deaths worldwide. Deaths by rabies most often occur in rural, uninformed, and unaware communities as seen in Figure 6. These people have little to no access to the healthcare needed to prevent this disease. Over 99% of rabies cases worldwide have lead to death leaving the survival rate of the disease, if not vaccinated, is less than 1%. To date only 10 cases of clinical rabies patients have survived due to administrations of two antibodies known to cure the disease, and injections of both rabies vaccine and globulin. What is the treatment for rabies? Rabies can be easily prevented with a rabies vaccination shot, though is very expensive even with healthcare. An average Americans pay for a shot ranges from $200 to $325 (CDC, 2011). However, the treatment for a post encounter with a nonvaccinated patient with rabies is very extensive. First, a series of shots is administered over the course of 14 days. Five injections are administered through the arm if in the case of rabies. (Jackson, Wunner 2007) The key to the treatment is the animal study, which occurs over a ten-day period in which the animal in question is observed for any sign of rabies. If the animal is not found the treatment is undergone either way, but if no sign of rabies is shown by the animal then the shots are unnecessary and the human does not have rabies.

Figure 7: Vaccinating and being aware of the disease can easily prevent rabies. What research has been done to prevent rabies? Although rabies is still a major public health problem resulting in more than 55,000 deaths a year, rabies has now become a virus easy to prevent before exposure (Furlong, 2005). Figure 7 is an example of an advertisement raising awareness of virus. The low-cost rabies vaccine released in 2012 promises a new era of immunization in poor, less-developed countries. However, the current vaccine is mainly for humans, canine vaccines may be available for the future (WHO, 2007). The research is ongoing and there will hopefully be a day with a clinical treatment to victims of rabies attacks. Prevention of rabies is a simple procedure of vaccination, and the continuation of help from the World Help Organization to provide global awareness of the disease helps every day. 22

References Rabies-Topic Overview. (2011, August 16). WebMD. Retrieved November 11, 2013, from http://www.webmd.com/a-to-z-guides/rabies-topicoverview A Rabies-Free World, Inc. - History. (N.d.). A Rabies-Free World, Inc. History. Retrieved November 11, 2013, from http://www.rabiesfree.org/page26.htm Signs and Symptoms. (2012, February 15). Centers for Disease Control and Prevention. Retrieved November 11, 2013, from http://www.cdc.gov/rabies/symptoms/ How Rabies Works. (n.d.). HowStuffWorks. Retrieved November 11, 2013, from http://science.howstuffworks.com/zoology/all-aboutanimals/rabies1.htm Rabies Cases in 2000. (n.d.). Centers for Disease Control and Prevention. Retrieved November 11, 2013, from http://www.cdc.gov/mmwr/preview/mmwr Staff, M. (2011, January 28). Definition. Mayo Clinic. Retrieved November 11, 2013, from http://www.mayoclinic.com/health/rabies/DS00484/DSECTION=treatmentsand-drugs Jackson, Alan C., and William H. Wunner. Rabies. Amsterdam: Elsevier/Academic, 2007. Print. "Vet's rabies crusade.(News)." Daily Record (Glasgow, Scotland) [glasgow] 17 Nov. 2005: 13A. Print.

"Clinical Infectious Diseases." Current Issues in Human Rabies Immunization. N.p., n.d. Web 12 Nov. 2013. <http://cid.oxfordjournals.org/content/10/ Animals. (n.d.). National Geographic. Retrieved November 15, 2013, from http://animals.nationalgeographic.com/animals/ MICROBIOLOGY AND IMMUNOLOGY ON-LINE. (n.d.). MICROBIOLOGY AND IMMUNOLOGY ON-LINE. Retrieved November 15, 2013, from http://www.microbiologybook.org Magazine. (n.d.). TIME. Retrieved November 15, 2013, from http://content.time.com/time/magazine/0,9263,7601131111,00.html Rabies. (n.d.). World Health Organization. Retrieved November 15, 2013, from http://www.who.int Safer Anesthesia, Better Surgery, Happy Pets. (n.d.). NW RSS. Retrieved November 15, 2013, from http://www.northwestpetclinic.com The Verge. (n.d.). The Verge. Retrieved November 15, 2013, from http://www.theverge.com rabies virus. (n.d.). rabies virus. Retrieved November 18, 2013, from http://fcps.edu/islandcreekes/ecology/rabi

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