Rabies is an acute infectious disease of the central nervous system in humans and mammals which have been fatal.
In humans theoretically, clinical symptoms consisted of 4 stages in a real situation is difficult to separate one from the other, namely:
- Nonspecific prodromal symptoms
- Acute encephalitis
- Brainstem dysfunction
- Coma and death
A variety of complications can occur in patients with rabies and usually occur in comatose. Neurologic complications can include increased intra-cranial pressure: abnormalities in the hypothalamus in the form of diabetes insipidus, syndrome of anti diuretic hormone abnormalities; autonomic dysfunction that causes hypertension, hypotension, hyperthermia, hypothermia, arrhythmias and cardiac arrest. Can be local or generalized seizures, and often in conjunction with arrhythmias and respiratory disorders. In the prodromal stage, common complications of hyperventilation and respiratory depression occurred in the neurological phase. Hypotension occurs due to congestive heart failure, dehydration and autonomic nervous breakdown.
Physical Examination of Rabies :
1. Respiratory Status
- Increased respiratory rate
- Temperatures generally increased (37.9 º C)
2. Nutritional Status
- Difficulty in swallowing food
- What is the patient's weight
- Nausea and vomiting
- Servings the meal was spent
- Ntritional status
3. Status Neuro-sensory
- Signs of inflammation
5. Ego integrity
- Clients feel anxious
- Clients do not understand about the disease
Neurologic Physical Assessment:
1. Vital signs:
- Blood pressure
- Pulse pressure
2. Fontanel head examination results:
- Prominent, flat, concave
- Common form of head
3. Pupillary Reaction
- Reaction to light
- The similarity of response
- The response to the call
- Lethargy and drowsiness
- Orientation to self and others
- Natural feeling
6. Seizure Activity
7. Sensory Function
- Reaction to pain
- Reaction to temperature
- Superficial tendon reflexes
- Pathological reflexes
Examination Support of Rabies
There are few checks on rabies are:
1. Electroencephalogram (EEG): fatherly used to help define the type and focus of the seizures.
2. CT scan: using X-ray studies are more sensitive than normal to detect differences in tissue density.
3. Magnetic resonance imaging (MRI): generating shadows using a magnetic field and radio waves, useful to show areas of the brain that are not clearly visible when using a CT scan.
4. Positron emission tomography (PET): to evaluate persistent seizures and helped establish the location of the lesion, metabolic changes in the brain or blood alirann.
5. Laboratory Test
- Lumbar puncture: fluid analyzed cerebrovascular
- Complete blood count: evaluate platelet and hematocrit
- electrolyte panel
- Toxic screening of serum and urine
- Blood Glucose: Hypoglycemia is a predisposition seizure less than 200 mq / dl
- BUN: Increased BUN, has the potential for seizures and an indication of the nephrotoxic effect of drug administration.
- Electrolytes: K, Na
- Electrolyte imbalance predisposes to seizure