Sign & Symptoms of Rabies

Initial Signs of Rabies

There are multiple phases of the rabies virus. Infected hosts may experience one, two or more of these phases. The following warning signs are associated with the earliest phase:

1. Restlessness
2. Apprehension
3. Biting or snapping
4. Licking, biting or chewing at the area of the infectious bite
5. Fever
6. Shyness
7. Irritability
8. Unusually docile behavior in an active animal
9. Aggression 

Progressive Signs of Rabies

As the virus moves from the muscle to the spinal cord, brain and eventually the saliva glands, different signs will appear. These symptoms usually occur in the last two phases of the virus:

10. Heightened sensitivity to light, touch or sound
11. Jaw hangs open
12.  Fear of water
13. Heavy breathing
14. Choking sounds or motions
15. Eating unusual items
16. Hiding in dark places
17. Paralysis of the hind legs or staggering
18. Loss of control over the throat
19. Foaming at the mouth
20. Dilated pupils
21. Loss of appetite
22. Weakness
23.Difficulty swallowing
24. Trembling
25. Disorientation or lack of coordination

Symptoms can appear as early as 10 days after the bite to as long as months afterward.

Short Note on Rabies

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Nutritional Problem # Jaundice

Jaundice is a yellowish colouration of the sclerae (whites of the eyes), skin and mucous membranes due to a build-up of a yellow compound called bilirubin. After bilirubin is formed from the breakdown of the heme pigment in aged red blood cells, it is transported to the liver, where it is processed and eventually excreted into bile.

The three main categories of jaundice are:

(1) Pre-hepatic jaundice, due to excess production of bilirubin;

(2) Hepatic jaundice, due to congenital liver disease — cirrhosis of the liver, or hepatitis; and

(3) Extra-hepatic jaundic due to blockage of bile drainage by gallstones or cancer of the bowel or the pancreas.

Because the liver of a newborn functions poorly for a week or so, many babies expe­rience a mild form of jaundice called neonatal jaundice that disappears as the liver matures. Usually, it is treated by exposing the infant to blue light which converts bilirubin into sub­stances the kidneys can excrete.

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Zoonotic Diseases

A zoonotic disease is a disease that can be spread between animals and humans. Zoonotic diseases can be caused by viruses, bacteria, parasites, and fungi. These diseases are very common. Scientists estimate that more than 6 out of every 10 infectious diseases in humans are spread from animals.

Many people interact with animals in their daily lives. We raise animals for food and keep them in our homes as pets. We might come into close contact with animals at a county fair or petting zoo or encounter wildlife when we clear wooded land for new construction.

Because of these interactions, it’s important to be aware of the different ways people can get zoonotic diseases. These can include:

• Coming into contact with the saliva, blood, urine, or feces of an infected animal
• Being bitten by a tick or mosquito (often called a “vector”)
• Eating or drinking something unsafe (such as unpasteurized milk, undercooked meat, or unwashed fruits and vegetables that are contaminated with feces from an infected animal)

Luckily, there are many ways you can protect yourself and your family from zoonotic diseases. You can:

• Always wash hands and follow proper hygiene
• Handle food safely
• Prevent bites from mosquitoes and ticks
• Know the simple things you can do to stay safe around your pets
• Be aware of zoonotic diseases both at home and when you travel

Presentations with additional information for veterinarians and physicians are available in the Resources section. These presentations have been developed to assist in discussions about zoonotic diseases and One Health.

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Factors involved in the transmission of Visceral Leishmaniasis

Mode of Transmission

Kala-azar is transmitted from person to person by the bite of the female phlebotamine sandfly, p.argentipes which is a highly anthrophilic species. Transmission may also take place by contamination of the bite wound or by contact when the insect is crushed during the act of feeding. Transmission of Kala-azar has also been recorded by blood transfusion, veneral and transplacental but are very rare.

Different factors involved in the transmission of kala-azar
Agent Factor:

1. Agents: Leishmania donovani, are intracellular parasites that infect and divide within macrophages is the causative agent of kala-azar.
2. Reservoir of infection: There is a variety of animal reservoirs e.g. dogs, jackals, foxes, rodents and other mammals. Indian kala-azar is considered to be a non-zoonotic infection with man as the sole reservoir.

Host Factor:

1. Age: Kala-azar can occur in all age groups including infants below the age of one year.
2. Sex: Males are affected twice as often as females.
3. Population movement: Movement of Population between endemic and non-endemic areas can result in the spread of infection.
4. Socio-economic movement: Kala-azar usually affects the poorest of the poor.
5. Occupation: The disease strongly associated with occupation. People who work in various farming practice, forestry, mining and fishing have a great risk of being bitten by sandflies.

Environmental Factors

1. Altitudes: Kala-azar is mostly confined to the plains, it does not occur in altitudes over 2000 feet.
2. Season: High Prevalence during and after rains.
3. Rural areas: The disease is generally confined to rural areas, where conditions for the breeding of sandflies readily exist compared to urban areas.
4. Vector: Only the female sandfly transmits the protozoa, infecting itself with the Leishmania parasites contained in the blood it sucks from its human or mammalian host. Sand fly breed in cracks and crevices in the soil and buildings, tree holes, caves etc.

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Leishmaniasis

Leishmaniasis is a parasitic disease caused by several species of genus Leishmania (protozoa) and transmitted by the bite of sand flies.Sand flies are primarily infected by animal reservoir, but humans are also a reservoir for some Leishmania species.Leishmaniasis currently threatens 350 million men, women and children in 88 countries around the world. The leishmaniases are parasitic diseases with a wide range of clinical symptoms:

1. Cutaneous leishmaniasis: Involving the skin at the site of a sandfly bite. Cutaneous forms of the disease normally produce skin ulcers on the exposed parts of the body such as the face, arms and legs. The disease can produce a large number of lesions-sometimes upto 200 causing serious disability.
2. Visceral Leishmaniasis: Involving liver, spleen and bone marrow. It is also known as Kala azar and is characterised by irregular bouts of fever, substantial weight loss, Hepatomegaly and Splenomegaly and anaemia. If left untreated, the fatality rate in developing countries can be as high as 100% within 2 years.
3. Mucocutaneous Leishmaniasis: Involving mucous membrane of the mouth and nose after spread from a nearby cutaneous lesion.Lesions can lead to partial or total destruction of the mucous membranes of the nose, mouth and throat cavities and surrounding tissues.
   

Marked enlargement of the spleen typical of visceral leishmaniasis in a patient in lowland Nepal. Photo: C. Bern, CDC.

Typical New World cutaneous leishmaniasis ulcer. Photo: B. Arana, MERTU, Guatemala.

 
Different species of  leishmania cause different disease.

1. Leishmania donovani causes Viceral leishmaniasis also called Kala-azar. The infection is generalized and the parasite is distributed in the internal organs. The parasite may also cause a variety of skin lesions (dermal leishmaniasis) without any visceral manifestations.
2. L. tropica, causes oriental sore. The infection is limited to a local lesion of the skin and subcutaneous tissues.
3. Leishmania brasiliensis causes Espundia. The infection is limited to a local lesion of the skin but may metastasise to other areas of skin and oro-nasal mucosa

Epidemiology

Leishmaniasis is endemic in more than 60 countries worldwide, including southern Europe, North Africa, the Middle East, Central and South America, and the Indian subcontinent. It is not endemic in SouthEast Asia and Australia. There are estimated 500,000 new cases of VL and more than 50,000 deaths from the disease each year.
The burden of cutaneous leishmaniasis disease (90% of cases) is borne by Afghanistan, Pakistan, Syria, Saudi Arabia, Algeria, Iran, Brazil and Peru and for Visceral leishmaniasis by India, Bangladesh, Nepal, Sudan and Brazil. Only India, Nepal and Bangladesh harbours an estimated 67% of the global VL disease burden.

VL in Nepal is mainly confined to the southern plain of the eastern and central regions, bordering VL endemic districts of Bihar state in India. Siraha, Dhanusa and Mohattari district are considered endemic with the disease. Occasional sporadic cases occur elsewhere. Around 5.5 million people live in affected areas, so are classified “at risk”.

A total of 25704 cases with 530 deaths were reported between 1980 and 2004 (440 cases per 100,000 in 20 years), and the case fatality rate in reported cases varied between 0.23 (in 1988) to 13.6 (in 1982).

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Pregnancy & Zika Virus

Women: Trying to get pregnant?

At this time, we don’t know how long Zika is present in semen in men who have had Zika, and we don’t know if men who had Zika but never developed symptoms can have Zika in their semen.  If you have a male sex partner who lives in or has traveled to an area with Zika and are concerned about trying to get pregnant, talk to your healthcare provider about

• His travel history
• How long he stayed
• If he took steps to prevent mosquito bites
• If you had sex without a condom

Men: Do you have a pregnant partner?

Zika virus can be spread by a man to his sex partners. Because of the link between Zika and birth defects, take steps to prevent your partner from getting Zika during her pregnancy. Talk to your doctor about what steps you can take.
If you live in or travel to an area with Zika, protect your partner’s pregnancy.
If you have vaginal, anal, or oral (mouth-to-penis) sex, use a condom the right way, every time, (warning: this link contains sexually graphic images) during the pregnancy.
OR
Don’t have sex with your pregnant partner during the pregnancy. Not having sex is the best way to be sure that someone does not get sexually transmitted Zika virus.
You should also take steps to prevent mosquito bites to prevent further spread of the virus.
If you think you may have or had Zika, tell your healthcare provider about

• Your travel history
• How long you stayed
• If you took steps to prevent mosquito bites
• If you had sex with your pregnant partner without a condom

Are you concerned about getting Zika from a sex partner?

• At this time, there is no evidence that women can transmit Zika virus to their sex partners.
• Only people whose male sex partners have traveled to or live in an area with Zika transmission need to be concerned about getting Zika from sex. Based on what we know today, traveling to or living in areas without Zika transmission does not pose a risk of getting infected with Zika.
• If you are concerned for any reason, you can use a condom the right way, every time, you have sex (warning: this link contains sexually graphic images). This includes vaginal, anal, and oral sex Condoms also prevent HIV and other STDs. Not having sex is the best way to be sure that you do not get sexually transmitted Zika virus.

Testing

There are tests to detect Zika virus in semen but they are not widely available. We have a limited understanding of how to interpret the results of such tests, so testing of semen is not recommended. As we learn more, these tests may become more helpful to determine the risk of sexual transmission of Zika.

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Transmission of Zika Virus

Through mosquito bites

Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (A. aegypti and A. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses.

• These mosquitoes typically lay eggs in and near standing water in things like buckets, bowls, animal dishes, flower pots and vases.  They prefer to bite people, and live indoors and outdoors near people.
  • Mosquitoes that spread chikungunya, dengue, and Zika are aggressive daytime biters. They can also bite at night.
• Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

From mother to child

• A mother already infected with Zika virus near the time of delivery can pass on the virus to her newborn around the time of birth.
• A pregnant woman can pass Zika virus to her fetus during pregnancy. We are studying the adverse pregnancy and infant outcomes associated with Zika virus infection during pregnancy.
• To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

Through sexual contact

• Zika virus can be spread by a man to his sex partners.
• In known cases of likely sexual transmission, the men had Zika symptoms, but the virus can be transmitted before, during, and after symptoms develop.
• In one case, the virus was spread a few days before symptoms developed.
• The virus is present in semen longer than in blood.

Through blood transfusion

• As of February, 1, 2016, there have not been any confirmed blood transfusion transmission cases in the United States.
• There have been multiple reports of blood transfusion transmission cases in Brazil. These reports are currently being investigated.
• During the French Polynesian outbreak, 2.8% of blood donors tested positive for Zika and in previous outbreaks, the virus has been found in blood donors.

Risks

• Anyone who lives in or travels to an area where Zika virus is found and has not already been infected with Zika virus can get it from mosquito bites. Once a person has been infected, he or she is likely to be protected from future infections.

Additional Resources

• MMWR: Transmission of Zika Virus Through Sexual Contact with Travelers to Areas of Ongoing Transmission — Continental United States, 2016
• Interim Guidelines for Prevention of Sexual Transmission of Zika Virus – United States, 2016
• Questions and Answers on Zika and Sexual Transmission
• Mosquito Life-Cycle
• Mosquitoes’ Main Aquatic Habitats

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Symptoms, Diagnosis, & Treatment of Zica Virus

Symptoms

• Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
• • See your healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to a place where Zika has been reported. Be sure to tell your health care provider where you traveled.
• The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito.
• People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected.
• Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people.
• Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

• The symptoms of Zika are similar to those of dengue and chikungunya, diseases spread through the same mosquitoes that transmit Zika.
• See your healthcare provider if you develop the symptoms described above and have visited an area where Zika is found.
• If you have recently traveled, tell your healthcare provider when and where you traveled.
• Your healthcare provider may order blood tests to look for Zika or other similar viruses like dengue or chikungunya.

Treatment

• There is no vaccine to prevent or medicine to treat Zika infections.
• Treat the symptoms:
  • Get plenty of rest.
  • Drink fluids to prevent dehydration.
  • Take medicine such as acetaminophen (Tylenol®) or paracetamol to relieve fever and pain.
  • Do not take aspirin and other non-steroidal anti-inflammatory drugs.
  • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
• If you have Zika, prevent mosquito bites for the first week of your illness.
  • During the first week of infection, Zika virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
  • An infected mosquito can then spread the virus to other people.

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