225.2 📚 國考版

225.2.0.1 必背 — Rabies Basic

• ssRNA bullet-shaped Rhabdoviridae / Lyssavirus
• Once symptomatic: ~ 100% fatal
• PEP if given before symptoms: essentially 100% effective

225.2.0.2 必背 — Reservoirs

• Africa + Asia: dogs (95% global cases)
• Americas: bats (USA primary), raccoons, skunks, foxes
• Europe: foxes (mostly controlled)
• Australia + bats: Australian bat lyssavirus

225.2.0.3 必背 — Transmission

• Bite + scratch + saliva on broken skin or mucous membrane
• Bat exposure (even without obvious bite — sleeping area awareness)
• Aerosol in caves (very rare)
• Organ transplant

225.2.0.4 必背 — Incubation

• 1-3 months typical (range 5 d - 7 yr)
• Shorter with proximal bites (face, scalp)

225.2.0.5 必背 — Clinical

• Prodrome (2-10 d): fever, malaise, pain/paresthesia at wound site
• Encephalitic (“furious”) 80%: hydrophobia + aerophobia + hypersalivation + agitation
• Paralytic (“dumb”) 20%: ascending flaccid paralysis (GBS mimic)
• Coma + death within 1-2 wk

225.2.0.6 必背 — Diagnosis

• Antemortem: skin biopsy nape of neck (sens 50-70%) + saliva/CSF PCR
• Negri bodies in Purkinje cells = pathognomonic postmortem

225.2.0.7 必背 — Post-Exposure Prophylaxis (PEP)

• Wound care (thorough soap + water + virucidal × 15 min)
• HRIG 20 IU/kg (infiltrate wound + remainder IM)
• Rabies vaccine 4-dose schedule (Days 0, 3, 7, 14)
• Immunocompromise: 5-dose (add Day 28)
• No HRIG if previously vaccinated (PrEP); just 2 doses Days 0 + 3

225.2.0.8 必背 — Pre-Exposure Prophylaxis (PrEP)

• 2 or 3 doses (lower vs higher risk)
• Veterinarians, animal handlers, lab workers, travelers, bat researchers

225.2.0.9 必背 — Bat Exposure

• PEP for any bite/scratch + suspected contact
• PEP if bat in bedroom of sleeping person

225.2.0.10 必背 — Small Rodents / Rabbits

• NOT typically rabid (don’t survive infection)
• Generally no PEP needed

225.2.0.11 必背 — 10-Day Observation

• Domestic dog/cat/ferret: 10-day observation
• If remains healthy: no PEP
• If develops symptoms: euthanize + test + start PEP

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