Recently, the emergency department of the First Affiliated Hospital of Zhejiang University School of Medicine admitted 46-year-old Li Ge, who suddenly suffered rabies more than a month after being bitten by a wild dog, and died after a week of rescue.
Thought it was pesticide poisoning
It turns out that TA is the culprit
Recently, Brother Li was sent to the emergency department of the First Affiliated Hospital of Zhejiang University School of Medicine by 120 ambulance. During the rescue, he was short of breath and babbling gibberish, not only continued to have convulsions, but also very manic, his hands were clenched into fists, he kept dancing, and kept spitting. The family was puzzled, how did Brother Li, who had always been in good health, suddenly become like this?
Brother Li has been working as a farmer in the local area because his family has a lot of tea fields. He picks tea when he is busy and grows vegetables in his spare time, and is the "pillar" of the family. A few days ago, when spraying insecticides on his tea mountain, Brother Li did not wear a mask and did no other protection, and then began to cough and have difficulty breathing, and his body temperature also rose to 38 °C.
"We all thought that he just had a cold and fever, and he would just go to the health center to hang up water, but who would have thought that he would be so sick." Brother Li's wife cried and recalled that he used anti-inflammatory drugs not only did not reduce the fever, but also had difficulty breathing, and the whole person was extremely irritable.
"The patient's muscles were stiff and twitching so hard that it took a lot of effort and sedatives to keep him under control!" Chief physician Lu Yuanqiang, director of the emergency department of the First Hospital of Zhejiang University, recalled that the family had been saying that it was pesticide poisoning, but judging from the patient's clinical manifestations, he had obvious photophobia, hydrophobia, and wind phobia.
It turned out that since a few days ago, Brother Li seemed to be unable to control himself, his hands would twitch unconsciously, and he couldn't sleep at night because of breathing difficulties, which intensified later.
"Is it possible that after being bitten by a dog for a month, you will still get sick? Impossible! Brother Li's wife recalled that her husband had been bitten by a wild dog when he was picking tea in the mountains a month ago, and when the dog pounced, he couldn't dodge, and was scratched by the dog's teeth on his right eyelid. Because there was no bleeding, Brother Li didn't care, and he didn't even clean the wound. And a week after being bitten, Brother Li also saw the body of the dog when he went up the mountain, and thought that he had been poisoned by eating unclean rat poison.
At present, there is no institution that routinely carries out rabies virus antibody and nucleic acid testing, and the etiological diagnosis of rabies is a major problem. After being sent to the infectious disease department, the expert team was in a hurry: they chose to extract the cerebrospinal fluid in Brother Li's spinal cord, and used high-throughput gene sequencing technology to catch the "culprit" of the disease within 24 hours after receiving the specimen - the pathogen was really the rabies virus! The rabies virus has an incubation period ranging from 5 days to several years (usually 2 to 3 months, rarely more than 1 year).
Case fatality rate is almost 100%
Infections can occur after being bitten by any of these animals
"After a person has rabies, the clinical manifestations are mainly excitement, fear of wind, hydrophobia, photophobia, dysphagia, salivation, mania, etc., at this time the virus has been widely distributed in the central nervous system and extraneural organs, no more than 10 days, the patient will die of brain damage or respiratory, circulatory and systemic failure." Director Lu Yuanqiang was very sorry for Brother Li's departure, and he explained that rabies, commonly known as rabies or hydrophobia, is a fatal infectious disease that can be prevented and incurable, and almost 100% of deaths once the disease occurs.
In the course of dealing with patients for more than 30 years, Director Lu has treated several patients infected with the rabies virus. These patients are not necessarily bitten by dogs, but also by cats, bats, etc. In addition, wild animals such as foxes, wolves, jackals, ferrets, badgers, raccoon dogs, skunks, raccoons, and mongooses are all natural reservoirs of rabies and can be infected with the rabies virus as a source of infection.
Director Lu Yuanqiang recalled that in September 2015, he had treated a middle-aged carpenter whose family lived in a rural area, and the carpenter accidentally scratched his right thumb while working, and the 1.5-centimeter wound was bleeding. He went to the village doctor for stitches, tetanus medicine, and a simple bandage. As a result, the carpenter's uncle was bitten on the right leg by a wild dog in the high-speed service area, and when he carried his uncle into the car, the gauze fell off, and the carpenter's wound came into contact with the wound of his uncle's dog bite. Two months later, the carpenter suffered from a series of symptoms such as photophobia, hydrophobia, wind phobia and insanity and was sent to Zhejiang for rescue, and was diagnosed with "rabies", and died due to the delay in rescue for too long. The carpenter's uncle went to get vaccinated against rabies the same day after he was bitten in July, and there were no complications. This tragedy is still fresh in his memory, and it shows the great harm of the rabies virus.
Because rabies virus is widely present in the saliva of the above-mentioned animals, it can invade the human body from broken skin (including fresh or unhealed wounds) or mucous membranes (including intact mucous membranes, such as the oral cavity, perineum, etc.), and be scratched, licked, bitten, even if the wound is relatively superficial and there is no bleeding, in fact, it may cause infection!
Level 1 Exposure:
It refers to intact skin-contact animals and their secretions and excretions, which are first-class exposure, risk-free, and do not need to be disposed of after exposure, but the contact parts need to be carefully cleaned.
Secondary Exposure:
It refers to bites and scratches without obvious bleeding, wounds without obvious bleeding, wounds that have been closed but not healed, and contact with animals and their secretions and excrements, which are secondary exposures and should be treated and vaccinated.
Level 3 Exposure:
Refers to wounds that include penetrating skin bites, scratches, or clinically manifested bleeding that have not yet closed, mucosal contact with animals and their secretions, and excretions that are exposed to the skin, requiring wound treatment, vaccination, and the use of passive immunization agents as appropriate.
So, what to do after being bitten by an animal suspected of carrying the rabies virus? Keep the following "four steps" in mind:
1. Immediately squeeze out the blood from the wound and rinse it repeatedly with soapy water (or other weak alkaline cleaning agent) and flowing water under a certain pressure for more than 15 minutes.
2. Wipe the wound with 2% iodine wine, 75% alcohol or other skin and mucosal disinfectants with virus inactivating effect, the wound should not be sutured or bandaged without authorization, no ointment or powder should be applied, and the doctor should be asked to do further wound treatment in a medical institution in time.
3. Within 24 hours of being bitten, immediately go to the community health service center for human rabies vaccination.
4. If the wound is very deep, in addition to the rabies vaccine, it is necessary to increase the injection of rabies immune serum or globulin.
Do this to avoid rabies
This season is the high incidence of rabies, cats and dogs are prone to irritability, usually docile they will occasionally lose their temper and even appear aggressive.
In the face of your own "master", no matter how much you love, it is best not to kiss or lick him. If you really can't help it, please vaccinate the "masters" against rabies first. In the face of strange cats and dogs, do not stroke at will, parents with children at home, to tell the babies to be bitten by cats and dogs must not endure not to say, to tell parents as soon as possible.
In fact, humanity has the most powerful weapon (and the only weapon) against rabies – the rabies vaccine. Rabies vaccination (± rabies immune globulin) following WHO norms after exposure can prevent 100% of rabies. The key point here is that the vaccination must be completed on schedule.
What should I do if I encounter a wild dog attack?
Don't panic and run, try not to look directly at the dog, take the initiative to throw out the bag and other items you carry with you for the dog to bite, or cover the dog's head with clothes to cover its eyes. When a vicious dog pounces, try to use a rope or leash within reach, and firmly strangle its neck or lift the dog collar to prevent it from breathing. If the dog is particularly aggressive, it is necessary to protect the head and neck and other vital organs to prevent fatal injuries.
Source: Orange Persimmon Interactive Urban Express reporter Jin Jing
