RABIA

DEFINITIE

• Boala infectioasa acuta

• V. rabic
• Tropism neurologic
• Tablou clinic de meningo-encefalita
• Letala
 ETIOLOGIA

• V. ARN
• V. neurotrop
• Fam Rabdoviridae, gen Lyssavirus
 EPIDEMIOLOGIA

• Raspandire universala, exceptie:

– Antarctica
– Noua Zeelanda
– Japonia
– Suedia
– Norvegia
– Spania
– Caraibe- unele insule
– Hawaii
• WHO- 30.000-70.000 decese/ an
 EPIDEMIOLOGIA
• Rezervor animal
– Domestic- cainii
– Salbatic
• Vulpile
• Lupii
• Bursucii
• Jderii
• Pisicile salbatice
• Dihorii
• Liliecii
– Rareori- rozatoare mici salbatice: soareci,
veverite, cobaii, sobolanii, iepurii
 EPIDEMIOLOGIA

• Cale de transmitere
– Muscatura animalului bolnav- saliva
– Transplant (cornee, organe)
 Histopatologic

• Corpusculii Babes- Negri =

– Incluzii intracitoplasmatice neuronale
Histopathologic examination of CNS tissue from autopsy showing neuronal
cytoplasmic inclusions (Negri bodies) after hematoxylin and eosin staining (left)
and rabies virus antigen (red) after immunohistochemical staining (right).
Centers for Disease Control and Prevention. Human Rabies---Kentucky/Indiana,
2009. MMWR Morb Mortal Wkly Rep 2010; 59:393.
Panel A shows a neuron without Negri bodies, while panel B
shows a Negri body in infected neuron (arrow). Panel C shows a
Negri body in Sellers stained brain tissue with dark blue
basophilic granules in the inclusion.
 PATOGENEZA

• Tropism pentru tesut nervos

• Raspandire de la locul inoculului spre SNC
• V de conducere- 50-100mm/zi
• Susceptibilitatea gazdei depinde de:
– Tulpina infectanta
– Inocul
– Inervatia de la locul muscaturii
– Imunitatea gazdei
 TABLOU CLINIC
• Incubatia- media 1-3 luni la om
– Limite- zile- ani
– Scurta pentru zone f. inervate- fata
• Tablou clinic – encefalopatie----deces
• Prodrom- zile – saptamani
– Subfebrilitati
– Frisoane
– Mialgii
– Cefalee
– Fotofobie
– Astenie
– Anorexie
– Disfagie
– Greturi, varsaturi
 TABLOU CLINIC

• La nivelul portii de intrare- plaga muscata

– Subiectiv
• Parestezii cu progresie proximala
• Arsura
• Durere
• Tensiune
• Prurit
• Neliniste
– Obiectiv- eritem, secretii purulente/ nimic
 TABLOU CLINIC

• FORME CLINICE
– Furioasa
– Paralitica
• F. atipice- muscatura de liliac, asociate cu deces
– Modificari de sensibilitate
– Miscari coreice ale membrelor
– S. de focar neurologic
– Paralizii de NC
– Mioclonii
– Convulsii
 TABLOU CLINIC

• HIDROFOBIA = patognomonic- 33-55%

– Spasm laringian dureros cand beau sau se pronunta
cuvantul apa
• AEROFOBIA= patognomonic- 9%
– Spasm inspirator dureros de pana 15 sec
– Urmat de tus, voma, aspirat, sughit
• CONTRACTURA
– Musculaturii fetei = grimase
– Musculatura paravertebrala = opistotonus
 TABLOU CLINIC

• Modificari vegetative
– Transpiratii
– Midriaza
– Hipersalivatie
– Hiperlacrimatie
– Hiper/hipotermie
– Tahicardie/ tulburari de ritm, modif ST-T
 TABLOU CLINIC
• Encefalita- 80% cazuri
– Disartrie
– Disfagie
– Diplopie
– Agitatie
– Vertij
– Agitatie
– Halucinatii
– Coma- paralizie flasca------ deces- stop respirator,
colaps vascular
 COMPLICATII

• Deces in 2 saptamani= evolutie naturala

• Pneumonie de aspiratie
• Asfixie (spasm laringian)- stop respirator
• Convulsii
• Artimie SV- miocardita , BAV, BNS, stop
cardiac
 DIAGNOSTIC POZITIV

• AE
• Clinic- parestezii la locul muscaturii
• Paraclinic
– Nespecific
• L↑
• LCR- Ly ↑, prot ↑, gluc-N
• CT craniu- edem cerebral difuz
• RMN- hipersemnal in hipocamp, HP, TC
 DIAGNOSTIC POZITIV

– Specific

• IF biopsie cutanata, saliva

• Izolarea v. rabic din saliva
• Ac anti v. rabic- LCR, ser, saliva, piele- tardiv
– In dinamica cu crestere pentru imunizati
• PCR- sange, piele, LCR, saliva
 DIAGNOSTIC DIFERENTIAL

• Meningo-encefalite HSV
• Tetanos
• Intoxicatii cu stricnina, fenotiazine
• Delirium tremens

• E. rabigena
– Rapid progresiva
– Hidrofobia
– Aerofobia
 TRATAMENT

• Etiologic nu exista
• Evolutie naturala spre deces
• Incercari
– Inducere de coma- ketamina, benzodiazepine
– RBV/ amantadina
– Ingrijire pacient critic
– Contraindicata vaccinarea, Ig specifice- pot
agrava boala- raspuns imun, penetrab in LCR