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Caz VD- F
• Muşcată de cîine (necunoscut) e !"-!# dec$%!! &a
ni'e&u& &eoei- d*
• Fă*ă +E+
• Efectuat V,A
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8/9/2019 Rabia 12
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E1 fizic &a inte*na*e
• 5istag0us 'e*tica&• ,*e0o* inten2iona&
• +e*ioade de contactu*i 0uscu&a*e
a&e0e0.*e&o*
• 6ensi.i&itate e1age*ată
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8/9/2019 Rabia 12
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E1 .io&ogice
• C, uşoa*ă &ă*gi*e a şan2u*i&o* inte*gi*a&e•
78!9!:%;00c
• +58"89%;!3/ ,+85/ u*ee8"
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8/9/2019 Rabia 12
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E'o&u2ie
• $"%$ 3a&ucina2ii auditi'e şi 'izua&e/ta3ica*dică/ cu
agita2ie si3o-0oto*ie
• $#%$ desatu*a*e i0o*tantă
I,
3,A
6to ca*diac i*e'e*si.i&
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8/9/2019 Rabia 12
7/25
• Perioada de incubaţie a *a.iei 8 foa*te
'a*ia.i&ă - înt*e zi&e şi ani (de o.icei 4%-@%de
zi&e)
• Perioada prodromală şi si0to0e&e c&inice
*ecoce au o du*ată de $-!% zi&e? a*estezii ;
du*e*e &a &ocu& 0uşcătu*ii/
sta*e gene*a&ă a&te*ată/ fe.*ă/ 0ia&gii/
cefa&ee/
g*ea2ă/ 'ă*sătu*i/ du*e*i a.do0ina&e/ dia*ee
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8/9/2019 Rabia 12
8/25
• Boala neurologică acută ($-# zi&e) oate fi
c&asificată în două fo*0e?1. ,,rabia furioasă ”( 80%):
agita2ie/ 3a&ucina2ii/ an1ietate/ tu.u*ă*i de
co0o*ta0ent/ 3id*ofo.ie/
con'u&sii/
disfunc2ii autono0e? ta3ica*die/ a*it0ii/3iotensiune
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8/9/2019 Rabia 12
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Profilaxia post- expunere
E1une*ea este *e*ezentată de?• 0uşcătu*a de ani0a& sau
o0/
• conta0ina*ea unei &ăgi desc3ise sau a 0ucoase&o*
cu sa&i'ă sau 2esut infectat de &a ani0a&e sau o0/•
sau contact si0i&a* cu 'i*usu& *a.iei/ 'iu
• Riscu& *a.iei duă 0uşcătu*a de ani0a& *a.igen
(:-
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8/9/2019 Rabia 12
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Circustan!e Con"uită
!+e*soană ne'accinată ante*io*
Ani0a&u& nu a fost catu*at
Ani0a&u& a decedat
Ani0a&u& t*ăieşte şi oate fi su*a'eg3eat
$+e*soană 'accinată ante*io*
Igiena &ăgii cu aă şi săun
I0unog&o.u&ină anti*a.ică? $% 0g;gc
Vaccina*e? ! 0& 'accin i0(0 de&toid) în
zi&e&e %/ 4/ #/ !9/ $
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8/9/2019 Rabia 12
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#ipul "e expunere
•
+e*soană ca*e a fost &insă e ie&ea intactă? nu
este
necesa*ă *ofi&a1ie
+&agă sue*ficia&ă/
Muşcătu*ă sau conta0ina*e cu sa&i'ă a unei
&ăgi
desc3ise a&e tegu0entu&ui; 0ucoasei?
I0unog&o.u&ine
u0ane şi 'accin
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8/9/2019 Rabia 12
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• ,3*oug3 $%%
-
8/9/2019 Rabia 12
15/25
$%%<
• Ke *e'ieJed indigenous& acLui*ed cases of
.at-'a*iant*a.ies in 3u0ans in Canada and t3e nited
• 6tates f*o0 !@:% t3*oug3 $%%#
• Results. f "! cases identified : occu**ed afte*
o*gan
t*ans&antation and Je*e e1c&uded f*o0 fu*t3e*
ana&sis• A .ite Jas *eo*ted . $$ (4@=) of t3e case atients/
@
(!"=) 3ad a di*ect contact (ie/ Je*e touc3ed . a .at)
• .ut no 3isto* of a .ite/ " (!!=) found .ats in t3ei* 3o0e
($ G9=H in t3e *oo0 J3e*e t3e s&et) .ut *eo*ted• no di*ect
contact/ and !@ (49=) *eo*ted no 3isto* of .at
e1osu*e J3atsoe'e*
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16/25
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8/9/2019 Rabia 12
17/25
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8/9/2019 Rabia 12
18/25
• n >D!/ uon diagnosis of *a.ies/ and afte* discussionJit3
t3e Ca&ifo*nia Dea*t0ent of +u.&ic >ea&t3/ CDC/and
aut3o*s of t3e M+?
• int*a'enous *i.a'i*in and ente*a&
a0antidine/tet*a3d*o.iote*in
• (B>9)/ coenz0e O!%/ and asco*.ic acid Je*e• initiated
• A&& su.seLuent tit*ations and 0odifications of t3e
M+
• Je*e 0ade in di*ect consu&tation Jit3 t3e M+
*i0a*in'estigato*
• *i.a'i*in 0a de&a t3e anti.od *esonse and is no
&onge**eco00ended G
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8/9/2019 Rabia 12
19/25
• n 3osita& da ! (>D!)/ di*ect f&uo*escent anti.od
(DFA)
• detected *a.ies 'i*us antigen in co*nea& i0*essions se*u0
and
• ce*e.*osina& f&uid (C6F) se*o&ogies Je*e negati'e
F*o0 a sa&i'a
• sa0&e on >D4/ 0o&ecu&a* testing e*fo*0ed at t3e
Cente*s fo*
• Disease Cont*o& and +*e'ention (CDC) detected *a.ies
'i*us
• R5A/ co**esonding genetica&& to +3i&iine dog
*a.ies Anti*a.ies• i00unog&o.u&in (Ig) Jas fi*st detected
'ia indi*ect
• i00unof&uo*escence in se*u0 and C6F on >D!! and
>D!4/
• *esecti'e& Initia& nuc3a& .ios Jas ositi'e . DFA
on >D4
• and again on >D!@
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8/9/2019 Rabia 12
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• i'en conce*ns fo* de'e&o0ent of
ce*e.*a&e&ect*ica& si&ence/
• 'asosas0/ and ede0a/ intense neu*o&ogic0onito*ing Jas
initiated
• ,3is inc&uded continuous
e&ect*oence3a&og*a0(EE)/
• continuous ce*e.*a& *egiona& o1gen satu*ation
0easu*e0ent . nea*-inf*a*ed sect*osco(5IR6)/ and dai&
t*ansc*ania& Do&e* (,CD)
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8/9/2019 Rabia 12
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• Ce*e.*a& 'asosas0 Jas suggested . ,CD on >D" and•
>D!%>D!$/ as *eo*ted e&seJ3e*e G4H 'asosas0-ta*geted
• t3e*aies inc&uded esca&ating doses of B>9/
fo&&oJed .
0i&*inone• and 7-a*ginine 6e*ia& EE *e'ea&ed
s&oJing/ *og*essing
to
• .u*st su*ession . >D!4 anticon'u&sant *o3&a1is
inc&uded fos3entoin/ 0idazo&a0/ and 3eno.a*.ita&• n
>D$! toi*a0ate Jas ad0iniste*ed fo* 0u&tifoca&
sies
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8/9/2019 Rabia 12
22/25
• ,3e 3osita& cou*se inc&uded 0u&ti&e
seconda*co0&ications *e'ious& desc*i.ed in *a.ies?t*ansient
3onat*e0ia/
• 3e0idia3*ag0atic a*a&sis/ anc*eatitis/
3ot3*oidis0/ and• 3ea*t .&oc *eLui*ing t*ans'enous acing
• Additiona& co0&ications inc&uded
'enti&ato*-associated neu0onia and e*i3e*a&
• t3*o0.o3&e.itis
• >osita&ization c3a*ges e1ceeded P#%% %%%
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8/9/2019 Rabia 12
23/25
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8/9/2019 Rabia 12
24/25
• As *eo*ted to date in t3e M+ Ra.ies Regist*/ 'a*iations
of
• t3e M+ 3a'e .een a&ied to $: additiona& atients/ Jit3
4• 0ini0a&& docu0ented su*'i'o*sSS G:H A gi*& f*o0
Co&o0.ia
• G"H and a 0an f*o0 +e*u died (>D#" and >D#%/
*esecti'e&)
• afte* *esu0ed 'i*a& c&ea*ance and disc3a*ge f*o0 t3e
IC/ f*o0
• non*a.ies att*i.uta.&e 0edica& co0&ications (R E
Ki&&oug3./• e*sona& co00unication/ $%!!) ,3e t3i*d
su*'i'o*/ a B*azi&ian
• .o Jit3 .at *a.ies G#H J3o *ecei'ed a*tia& +E+ .efo*e
onset of
• s0to0s/ is &i'ing at 3o0e
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8/9/2019 Rabia 12
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• enetic 'a*ia.i&ities in t3e 3ost and 'i*us&ie&
cont*i.ute to su*'i'a& Indeed/ t3e*e
a*e *eo*ts of ani0a&s su*'i'ing *a.ies
Jit3out t3e*a G!!H• ,3us/ a&ication of t3e M+ 0a .e 0o*e
successfu& in secific su.g*ous of atients
