WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Ext., Cabanatuan City, Nueva Ecija, Philippines, 3100
A.Y. 2022 – 2023
RABIES
Presented By:
Amolo, Xennia Atasha H.
Bernardo, Louella Mae A.
Erum, Kate Husslein D.
Guzman, Nique B.
Marquez, Maria Sandra G.
Papio, Jhelvie R.
Samen, Kirsten Mae B.
Sanidad, Mary Angeline A.
Tenorio, Dominique Nichole D.
Villajuan, Alexi Riea D.C.
Yadao, Mica Jarra M.
BSN 2-9
CASE SCENARIO
This is a case of an 18-year-old woman of S. Family named Ms. A.S. During home
visitation, it can be seen that their family has a lot of dogs. There are 3 dogs in their house:
an Azkal and a Belgian Malinois are staying outside and a Shiz Tzu is staying inside of their
house. They have been taking care of dogs for (ilan years na nag-aalaga ng dog?). Upon
interview, she said that she was bitten by their family dog last month, November 01, 2022.
Their dog has already an anti-rabies vaccine. The patient said that she was just hugging and
playing with their dog when it bit her on the neck. The scar caused by the dog bite has bled.
She didn’t tell her family right away after she was bitten by their dog because she was
scared. The patient showed no signs or symptoms of rabies. She was vaccinated last
November 05, 2022. Equirab vaccine and Abhayrab are the vaccines received by the
patient.
Problem Identified: Rabies
Date Identified: November 05, 2022
Date Evaluated: December 10, 2022
DEFINITION
Rabies is primarily found in animals (Centers for Disease Control and Prevention,
2019).
Transmitted thru saliva by a rabid animal via scratches or bites (Centers for Disease
Control and Prevention, 2019).
Affects the central nervous system (NHS, 2020).
Abstaining from treatment can result in the death of a scratched/bitten person (WHO,
2021).
Rabies is a vaccine-preventable disease (WHO, 2021)
CATEGORIES OF DOG BITE
Categories Experienced by the Patient
CATEGORY I
Licking or touching on intact skin
CATEGORY II
Saliva on scratches or abrasions on
the skin without bleeding or nibbling
of uncovered skin
CATEGORY III Dog bite in the neck
Bites or scratches that penetrate the
skin. Exposure of the eyes or mouth
to saliva from licks.
SYNONYMS
1. Hydrophobia
2. Lyssa
3. Canine Madness
4. Madness
5. Zoonotic Disease
6. Fear of Light
CAUSATIVE AGENT
Rabies is caused by a lyssavirus (a form of a virus that causes encephalitis) that
affects the saliva and nervous system. A bite or scratch causes most cases of rabies in
humans from an infected animal. It is possible, but rare, for people to get rabies if infectious
material from a rabid animal, such as saliva, gets directly into their eyes, nose, mouth, or a
wound.
RISK FACTORS
A. Modifiable
Modifiable Risk Factors Present in Patient
Marginalized and rural areas Gapan City, Nueva Ecija
Exposure to infected animals’ Dog bite on the neck
secretions
B. Non-Modifiable
Non-Modifiable Risk Factors Present in Patient
Geographic location Nueva Ecija, Phillipines, Asia
CLINICAL MANIFESTATIONS
Subjective Cues:
“Niyakap ko lang ang aso naming kasi nacu-cute-an ako sa kanya, kaso masyado
atang napahigpit kaya kinagat ako sa leeg, nagalit tuloy siya. Nagsugat at dumugo ng
bagya.” As verbalized by Ms. A.S.
Objective Cues:
Wound in the neck.
Pain scale of 5 out of 10, with 10 as the most painful. (No medication prescribed)
The patient showed no signs and symptoms because the patient received an anti-
rabies vaccine 5 days after she was bitten.
Signs and Symptoms Experienced by the Px
Headache None
Fever
Fatigue
Tingling at site of exposure
Hallucinations
Excessive salivation
Hydrophobia
Insomnia
Aggression
Light sensitivity
DIAGNOSTIC TESTS
Diagnostic Tests Experienced by the Patient
Skin Test Skin Test
Lumbar Puncture
Skin Biopsy
Blood Tests
Head MRI or CT Scan
PATHOPHYSIOLOGY
Patient contact with Rabies virus enters the Entry of the
an animal with rabies body thru open wound virus
Replication occurs in Enters into nervous Enters in
the spinal cord system muscle cells
Enters Virus spreading into Virus enters salivary
brain CNS glands
Aggression, Symptoms Cornea and
hallucinations appear tonsils
Light Excessive salivation,
sensitivity madness Death
OBJECTIVE MANAGEMENT
Wound Care
For many types of bite wounds, immediate gentle irrigation with water or a dilute water
povidone-iodine solution has been shown to markedly decrease the risk of bacterial
infection. Wound cleansing is especially important in rabies prevention since, in
animal studies, thorough wound cleansing alone without other post-exposure
prophylaxis has been shown to markedly reduce the likelihood of rabies.
In order to avoid inoculating the virus deeper into the tissues, wounds are either not
sutured at all or are left open and re-evaluated in 48-72 hours, with a view to possible
closure.
MEDICAL MANAGEMENT
Medical Management Received by the Patient
Rabies Immunization Abhayrab Vaccine & Equirab Vaccine
Tetanus Immunization Tetanus Immunization
Antibiotics
Medications prevent an infection from traveling to your brain if you’ve been exposed
to rabies (post-exposure prophylaxis/PEP). These medications are often combined:
1. Rabies vaccine. The vaccine teaches your body to destroy the rabies virus before
it enters your brain.
2. Human rabies immune globulin (HyperRAB). HRID gives antibodies (molecules
that fight infection) that will destroy the virus near the wound until body takes over.
3. Post exposure prophylaxis (PEP). Consists of a dose of human rabies immune
globulin (HRIG) and rabies vaccine given on the day of the rabies exposure. The
combination of HRIG and vaccine is recommended for both bite and non-bite
exposures, regardless of the interval between exposure and initiation of treatment.
Abhayrab Vaccine (vaccine administered to the patient)
It is given to people after an animal bite if the animal could have rabies. If the vaccine
is given immediately and appropriately, it is 100 percent effective.
Equirab Vaccine (vaccine administered to the patient)
It provides passive immunization against rabies. For prevention of rabies in patients at
risk of being exposed to rabies after contact with a rabid animal or an animal
presumed to be rabid. Equirab itself does not constitute an antirabies treatment and
should always be used in conjunction with the rabies vaccine.
SURGICAL MANAGEMENT
Highly contaminated wounds, or wounds that may compromise function, require
surgical management (exploration, removal of foreign material, excision of necrotic
tissue, copious irrigation with sterile 0.9% sodium chloride or Ringer lactate, with local
or general anaesthesia).
Surgical Management Experienced by the Px
Exploration NONE
Removal of foreign material
Excision of necrotic tissue
Copious irrigation with sterile 0.9%
NaCl or LRS, with local or general
anesthesia
COMPLICATIONS
Complications
Seizures
Fasciculation
Psychosis
Aphasia
Autonomic Instability
Paralysis
Coma
Death
PREVENTIONS
Vaccinate dogs against rabies.
Keep and maintain your pets under control.
Leave stray or unknown dogs alone.
Wash dog bites or scratches with soap and water immediately.
Disinfect animal bite with a betadine or an alcohol.
If bitten, scratched or unsure, immediately consult to a doctor, nearest health facility
or animal bite center.
If bitten, scratched or have contact with a dog, monitor the dog if it will turn wild or
stray.
Socialize your dog to other people.
Teach family members on how to approach dogs.
Teach family members about rabies.
DOH PROGRAM
Rabies Prevention and Control Program
Rabies is a human infection that occurs after a transdermal bite or scratch by an
infected animal, like dogs and cats. It can be transmitted when infectious material, usually
saliva, comes into direct contact with a victim’s fresh skin lesions. Rabies may also occur,
though in very rare cases, through inhalation of virus-containing spray or through organ
transplants.
Rabies is considered to be a neglected disease, which is 100% fatal though 100%
preventable. It is not among the leading causes of mortality and morbidity in the country but
it is regarded as a significant public health problem because (1) it is one of the most acutely
fatal infection and (2) it is responsible for the death of 200-300 Filipinos annually.
Components:
Post Exposure Prophylaxis
Pre- Exposure Prophylaxis (PrEP)
Health Education and advocacy campaign
Training/Capability Building
Training on National Rabies Information System (NaRIS)
Establishment of ABTCs by Inter-Local Health Zone
DOH-DA joint evaluation and declaration of Rabies-free areas/provinces
USED PICTURES
Patient’s
Vaccine Card
Ms. A. S.
(patient)
REFERENCES
Definition
(2022, December 8). Rabies. Centers for Disease Control and Prevention. Retrieved
December 13, 2022, from https://www.cdc.gov/rabies/index.html
World Health Organization. (n.d.). Rabies. World Health Organization. Retrieved
December 13, 2022, from https://www.who.int/news-room/fact-sheets/detail/rabies
NHS. (n.d.). NHS choices. Retrieved December 13, 2022, from
https://www.nhs.uk/conditions/rabies/
Signs and Symptoms
Signs and symptoms of rabies. Global Alliance for Rabies Control. (n.d.). Retrieved
December 13, 2022, from https://rabiesalliance.org/about/about-rabies/signs-and-
symptoms-rabies
Causes
Rabies. NORD (National Organization for Rare Disorders). (n.d.). Retrieved December
14, 2022, from https://rarediseases.org/rare-diseases/rabies/
Risk Factors
World Health Organization. (n.d.). Rabies. World Health Organization. Retrieved
December 14, 2022, from https://www.who.int/news-room/fact-sheets/detail/rabies
Johnson, S. (2018, September 17). Symptoms of rabies in humans, risk factors, how to
prevent IT & more. Healthline. Retrieved December 14, 2022, from
https://www.healthline.com/health/rabies#risk-factors
Complications
Rabies - statpearls - NCBI bookshelf. (n.d.). Retrieved December 13, 2022, from
https://www.ncbi.nlm.nih.gov/books/NBK448076/
Pathophysiology
Typical representation of the pathogenesis of rabies virus, where the ... (n.d.). Retrieved
December 13, 2022, from https://www.researchgate.net/figure/Typical-representation-of-
the-pathogenesis-of-rabies-virus-where-the-virus-infects-the_fig3_321874302
Aryal, S., NOURLIL, J., Nourlil, J., Seiler, E., Chatterjee, B., Lawal, S., Chawinga, K.,
Mehdi, M. B., & saleh, M. (2022, September 5). Rabies virus- an overview. Microbe
Notes. Retrieved December 14, 2022, from https://microbenotes.com/rabies-virus/
Diagnostic Tests
Wong, C. (2022, May 12). How rabies is diagnosed. Verywell Health. Retrieved
December 14, 2022, from https://www.verywellhealth.com/how-rabies-is-diagnosed-
4164513
Medical Management
Rabies: Causes, symptoms, treatment & prevention. Cleveland Clinic. (n.d.).
Retrieved December 14, 2022, from
https://my.clevelandclinic.org/health/diseases/13848-rabies
Surgical Management
Rabies surgery. wikidoc. (n.d.). Retrieved December 14, 2022, from
https://www.wikidoc.org/index.php/Rabies_surgery
Nicolle, L. (2002, March). Rabies: Still with Us. The Canadian journal of infectious
diseases = Journal canadien des maladies infectieuses. Retrieved December 14, 2022,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094859/
Preventions
Centers for Disease Control and Prevention. (2019, June 11). Rabies prevention.
Centers for Disease Control and Prevention. Retrieved December 14, 2022, from
https://www.cdc.gov/rabies/prevention/index.html
Dog bite prevention. American Veterinary Medical Association. (n.d.). Retrieved
December 14, 2022, from https://www.avma.org/resources-tools/pet-owners/dog-bite-
prevention
DOH Programs
Rabies prevention and control program: Department of Health Website. Rabies
Prevention and Control Program | Department of Health Website. (n.d.). Retrieved
December 14, 2022, from https://doh.gov.ph/national-rabies-prevention-and-control-
program
