Rabies reminiscing

March 19, 2008

The ferocious barking of furious animals crashed through my senses and broke the rhythm of my serene morning jog around the soccer field. I turned to see 3 weimeraners charging at full bore towards me. I stopped running and stood still, hoping they would stop if they didn’t have something to chase after. They didn’t, and suddenly three snarling dogs were apon me with their teeth bared and bodies tensed to pounce. Well this would turn any dog lover a bit off.

“Nice doggie”, I said in a soothing tone. One dog paused, but continued to bark with back arched, hair bristleing, and lips curled back over teeth. The second dog, a bony nursing female with eight teats swinging from her chest paid no heed and lunged at me. Both paws landed on my chest and I grabbed her front legs to hold her chopping mouth away from me. She then proceeded to whip her head around and clamp her teeth onto my right arm. I let go of her legs and she dropped to the ground. She backed up a few paces and crouched low. She looked ready to jump again and I wondered if she would go for the jugular. Should I cover my neck or my head? What would my book on avoiding catastrophes say? Would I look under “D” for dogs, or “R” for rabid dogs, or “F” for ferocious attacking dogs? At any rate I could see the whites of this dog’s eyes, the way every canine glinted beneath the curled lips, and the tension of every muscle under the grey flashing hide, and man’s best friend was not a picture that came to mind.

I still could not believe they were actually attacking me. These were the three Weimeraners that jogged lazily around the grounds of “Rumipamba de las Rosas”, the hotel I was staying at. I’ve heard these dogs are actually called “The Velcro dog’s “ for their affinity to their owners and desire to be by their side. So where was the hook to this Velcro? I obviously had the teeth.

I was debating whether or not to throw the cell phone I was carrying at the dog’s bared teeth. But then what if I broke the cell phone? It wasn’t actually mine, and I didn’t want to have to pay for a new one. But then that was silly, wasn’t it? Certainly the cell phone wasn’t worth a jugular. I decided to adjust my position and angle the throw so the cell phone would land on grass and not on rock. Both the cell phone and jugular were saved when the dogs suddenly spun around and darted out of sight. They must have found their Velcro.

The dog hadn’t torn my long sleeved shirt and it was more pressure I felt at the area of the bite. I could see one small puncture wound, a red mark on my wrist and a few teeth shaped bruises, but that was all. I picked up a rock and kept on running.

Later I told the host that one of their dogs had bitten me. “They gave me a nice little smile and said,”I’m sorry”. Then they gave me the bill. I didn’t know how to ask if the dogs had been vaccinated against rabies and left with my bite mark. When someone else in our party mentioned to one of the staff that I had been bitten while running, their comment was,” She shouldn’t have been running”. As if it was my fault that I had been bitten by one of their dogs while running around a game field.

I haven’t developed any frothing of the mouth yet, but I have done some googleing on rabies, and it’s not a pleasant disease. Becky, a newly arrived Doctor at Hospital Vozandes del Oriente, nurtured every conceivable fear as she happily told me every morbid detail of contracting rabies.

“I seriously doubt the dog that bit you had rabies, BUT, rabies is fatal and there is no cure.” She said as we jogged along our route past the smoking volcanoes toward the town of Madre Tierra.

“But surely there are symptoms, you must know something is wrong,” I said.

“Nope, she countered. There can be no symptoms.”

“You must have some redness, or inflammation around the wound. You must have something.”

“Not necessarily, she said. It can take 10 days to develop symptoms and by then it’s too late. You always die. And here’s the kicker, you can be perfectly fine for two years, then all of sudden it hit’s you with certain death to follow.” (Notice the emphasis on death, fatal, and dying.)

“Well, I don’t think I have rabies.”

“I’m pretty certain you don’t either, but as a Doctor I’d advise you to get the vaccination. Why take the chance.”

I didn’t think not liking really big needles was probably a very good excuse.

While I was deciding whether or not to get the series of rabies shots, I looked into the history of rabies. It’s actually a pretty interesting fatal disease. All sorts of little known factoids of interest here. The following is what turned up on a google search.

Rabies (Latin: rabies, "madness, rage, fury") is a viral zoonotic neuroinvasive disease that causes acute encephalitis (inflammation of the brain) in mammals. In non-vaccinated humans, rabies is almost invariably fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival in which the patient received no rabies-specific treatment either before or after illness onset. Rabies has been recognized for over 4,000 years. Yet, despite great advances in diagnosing and preventing it, today rabies is almost always deadly in humans who contract it and do not receive treatment.

Rabies-free jurisdictions, as of January 2006:
Australia, New Zealand, Fiji, Guam, Hawaii, the United Kingdom, Republic of Ireland, Norway, Sweden, Finland, Iceland, Japan and Taiwan/ROC.

Cats, dogs, and cattle account for nearly 90 percent of rabies cases in domestic animals, with horses, mules, sheep, goats and ferrets making up the remaining cases.

Among wild animals, the disease is most often reported in skunks and raccoons. Other wild species in this country in which rabies is commonly found include bats, foxes, and rodents.

The rabies virus, present in the saliva of an infected animal, is usually spread by a bite or scratch that punctures the victim's skin. The virus has a strong affinity for cells of the nervous system. It enters nerve cells at the site of the wound, travels to the brain, and then follows other nerve pathways to the muscles and organs. It also invades and damages the muscles involved in drinking and swallowing.

There are at least two other ways in which humans have been known to have contracted rabies, both extremely rare. Two people were exposed by breathing the air in caves inhabited by rabid bats, and six people contracted rabies following implants of corneas from donors who had undiagnosed rabies.

Most human victims, and apparently lower animals as well, suffer excruciating pain on swallowing liquids. Though they suffer from thirst, animal and human rabies victims are terrified by the sight of water. Another name for the rabies disease is hydrophobia.

Rabies can be totally prevented. You must recognize the exposure and promptly get appropriate medical care before you develop the symptoms of rabies.
• Where rabies is found: Human rabies is quite rare in the United States. Only 27 cases have been reported in people in the United States since 1990. Yet in some areas of the world (for example, Southeast Asia, Africa, and Latin America), human rabies is much more common. The incidence of rabies in people parallels the incidence in the animal kingdom. The great strides that have been made in controlling the disease in animals in the United States and in other developed countries is directly responsible for this decline in human rabies.

◦ Although rabies in humans is very rare in the United States, between 16,000 and 39,000 people receive preventive medical treatment each year after being exposed to a potentially rabid animal.

◦ Rabies in wildlife accounts for greater than 85% of animal rabies in the United States.

• Animals that carry rabies: Raccoons are the most common wild animals infected with rabies in the United States. Skunks, foxes, bats, and coyotes are the other most frequently affected.

◦ Bats are the most common animals responsible for the transmission of human rabies in the United States, accounting for more than half of human cases since 1980, and 74% since 1990. Rabid bats have been reported in all states except Hawaii.

◦ Cats are the most common domestic animals with rabies in the United States. Dogs are the most common domestic rabid animals worldwide.

◦ Almost any wild or domestic animal can potentially get rabies, but it is very rare in small rodents (rats, squirrels, chipmunks) and lagomorphs (rabbits and hares). Large rodents (beavers, woodchucks/groundhogs) have been found to have rabies in some areas of the United States.

◦ Fish, reptiles, and birds are not known to carry the rabies virus.

Normally between three weeks and three months can pass between infection and the onset of symptoms (incubation period). But in individual instances, it may be as much as several years.

In spite of being bitten by an animal with rabies, it is not certain that you have been infected. Only one out of six people who have been bitten develop symptoms - even if they have not been treated.

If you get rabies and do not manage to be treated in time, the disease evolves in two phases:


The prodomal phase (prelude)

In this phase, the patient may have a fever, vomiting and loss of appetite, headache and pain at the site of the original bite.

The autonomic nervous system is affected. This manifests itself as copious salivation and weeping.


The neurological phase

Paralysis may occur in this phase. In particular, there are spasms in the throat, making swallowing difficult.

The person affected becomes terrified of water (which is why it's also called 'hydrophobia') and becomes anxious and hyperactive.

It is in this phase that animals become mad and bite. Symptoms such as those seen in encephalitis are also present, along with increasingly uncontrolled movement, confusion and delirium.


Prospects

Once visible symptoms have developed, the mortality rate is almost 100 per cent. Very few people are known to have survived a rabies infection.

And a case history of a 23 yr old English woman for those interested in morbid details:

"On June 17, 1981 she was bitten on the ankle by a dog in New Delhi. On August 18, about two months later, she experienced the first prodromal symptoms. She became anxious and depressed, and it became impossible for her to drink more than small sips of liquid. While sleeping, she frequently sat up in bed suddenly, terrified. On August 19, she became confused, hallucinated, and was incontinent of urine. On August 20, she was unable to eat or drink and was taken to the hospital where she hallucinated and screamed in terror. Misdiagnosed as a psychiatric case, she was injected with a tranquilizer and sent home, however she repeatedly woke up screaming in fear and became so wild and agitated that her husband felt he could not deal with her by himself and took her to her mother's house. She remained terrified, hallucinating and screaming in horror throughout the night. She had no water for almost three days. She fell into a coma the next morning, and died on August 23."

That being said, I got the rabies vaccination.