Bites by mammals and rabies

Notes
  • The most common of animal bites globally are bites by dogs, cats and human in that order.
Symptoms
  • Malaise
  • Fever
  • Headache
  • Itching and paraesthesia at the site of bite
  • Encephalitis (manifested by dumbness and agitation)
  • Hydrophobia
  • Paralysis
Diagnosis
  • Suspected rabies infection in the biting mammal.
  • MRI scan revealing basal ganglial lesions
Management
  1. General management of mammalian bites
  • Wound cleaning with soap or irrigation with a lot of normal saline water.
  • Debridement
  • Anti-tetanus
  • Prophylactic antibiotics (may be considered)
  • Treatment of subsequent infections.   
  • Management of a suspected bite by rabid mammal
  • See bullet (2) above under the “General management of mammalian bites”
  • Post-exposure prophylaxis (PEP) with anti-rabies vaccine in case of the following: a bite from wild or unprovoked or a sick looking domestic animal; the presence of Negri bodies in the brain of the biting animal; severe bites and bites of the head, neck, face, hands or fingers.
  • The dose of rabies PEP is administered as follows:

* Passive immunization by infiltration of the wound with the rabies immunoglobulin at a dose of 20IU/kg then  20IU/kg IM at gluteal region.

   Then,

* Active immunization in patients not earlier vaccinated:

   **6 inj of 0.1ml intradermal (forearm or upperarm) given after bite, immediately, 3, 7, 14, 30 and 90 days

    OR

   1ml IM given after bite, immediately, 3, 7, 14 and 21 days

* Post-exposure prophylaxis (PEP) for a person previously vaccinated against rabies: 1-mL IM injections on days 0 and 3.

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