Clinical analysis of 15 cases of death rabiesOu Qiang Tang XuyingDepartment of infectious diseases, public health center, Fudan University,
Clinical analysis of 15 cases of death rabies
Ou Qiang Tang Xuying
Department of infectious diseases, public health center, Fudan University, Shanghai 201508, China
In recent years, the rabies epidemic has picked up, and the patients are increasing year by year. In this paper, the data of 15 patients with rabies were analyzed:
1 clinical data
1.1 general data of 15 death cases, 11 cases were male, 4 were female, aged 16 - 62 years old, the median age was 31 years old, are in our hospital from April 2004 to March 2006 of infectious diseases in hospitalized patients, the diagnosis of infectious diseases "practical" clinical criteria for the diagnosis of rabies virus . 15 patients in addition to the suburbs of Shanghai for 1 people, the rest are to Shanghai workers. All patients had a history of dog bite. 5 cases (33.3%) patients bitten by dogs without any treatment, 5 cases (33.3%) were treated by alcohol or mercurochrome disinfection bite site, 4 cases (26.7%) only planned vaccination without injected antivenom, 1 cases (6.7%) according to the plan by the vaccine and antitoxic serum.
1.2 there were 9 cases of biting and lying in the lower limbs, and those who had bitten upper limbs were treated in 6 cases. Incubation period (from dog bites to symptoms) for 3 years, the shortest period of 25 days, the incubation period of 73.3% (11/15) within six months.
1.3 clinical manifestations of 13 cases of hydrophobia (86.7%), 12 cases of nausea, vomiting and other gastrointestinal symptoms (80%), fear of wind, afraid of light in 8 cases (53.3%), 7 cases (46.7%) Dan flow, laryngeal spasm in 7 cases (46.7%), 6 cases of fever, headache, irritability (40%) 6 cases (40%), 3 cases (20%), in 3 cases of abnormal wound numbness, itching, feeling (20%), 1 (6.7%) cases of spermatorrhoea. 12 cases of patients with total number of white blood cells increased in (10 to 20 * 109 /L), red blood cells and platelets in normal. Tachycardia in 10 cases, 8 cases of arrhythmia.
On the 1.4 treatment and prognosis after be sedative (654 - 2, stability), antiviral (ribavirin), rehydration and symptomatic treatment, her condition did not improve, the excitement gradually quiet, appear to paralysis, feeling disappeared, was in a coma like hours, breathing and heartbeat stop death. Time from onset to death was 12 days, the shortest was 5 days. The causes of death were respiratory and circulatory failure.
The main source of rabies in China was the sick dog (80% - 90%), followed by sick cat and sick wolf . Most of the patients infected with rabies virus in dogs and cats and other animal bites after 1-2 months after the onset of the first symptoms were wound numbness, formication, followed by throat muscle spasm, restlessness, the typical symptoms of hydrophobia, fear of wind, salivate, which is an important basis for clinical diagnosis rabies. This group of patients with the longest incubation period of 3 years, the shortest period of 25 days, the latency of the patients with 73.3% (11/15) within six months, after the onset of typical rabies, so the clinical diagnosis. It is worth noting that there are a number of patients reported in the early course of the disease in patients with sexual desire, mainly for the continuous large number of seminal . There were 1 cases of early onset of incubation period of 1 years, 2 consecutive days of ejaculation, and irritability, frequent convulsions, typical symptoms and was eventually diagnosed hydrophobia. It is suggested that clinicians should improve the understanding of the first symptoms of rabies and reduce misdiagnosis.
At present, there is no specific treatment for rabies, once the incidence, mortality rate of 100%, so the prevention of the disease is the most important. After the injury treatment should be correct and timely, including: after being bitten by dogs and other animals, regardless of whether the animal is healthy, should immediately use 20% of soap water or the new cleaning of the wounds of the second half of the clean up more than half an hour 0.1%. Open wound dressing, suture. The injection within 72 hours of anti rabies virus serum 2, around 1 of 1 intramuscular injection of wound closure. Hamster kidney rabies vaccine 2ml by 0, 3, 7, 14, 30 days of the injection of 1, serious person can bite in fiftieth days, 90 days to strengthen the injection of 1 doses of vaccine. Timely local injection of anti rabies serum and whole injection of rabies vaccine to prevent the disease is very important, can significantly reduce the incidence of rabies. The correct treatment of the wounds and the whole course vaccination and injection of antivenom are indispensable. The 14 patients in this group were not taken positive preventive measures after the dog bites, and can not be effectively protected. 1 cases were still affected by the above treatment, but they were seriously infected.
Health care and disease control agencies should strengthen the propaganda and education on the prevention of rabies, minimize the incidence of rabies, the CDC staff to strengthen the quality supervision and management of vaccine and antivenom.
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