225.4 📌 章末速蚘

  • Rabies: ssRNA Rhabdoviridae / Lyssavirus, bullet-shaped, retrograde axonal transport to CNS
  • Reservoirs: dogs (Asia + Africa, 95%), bats (USA primary), wild carnivores
  • ~ 59K human deaths/yr globally; 95% in Asia + Africa
  • Once symptomatic: ~ 100% fatal
  • PEP essentially 100% effective if before symptoms
  • Clinical:
    • Prodrome with wound site paresthesia (pathognomonic)
    • Encephalitic 80%: hydrophobia + aerophobia + hypersalivation + agitation
    • Paralytic 20%: ascending flaccid paralysis (GBS mimic)
  • PEP:
    • Wound care + HRIG 20 IU/kg + 4-dose vaccine (Days 0, 3, 7, 14)
    • Immunocompromise 5-dose (add Day 28)
    • No HRIG if previously vaccinated; just 2 doses (Days 0, 3)
  • PrEP: 2 or 3 doses for high-risk
  • Bat exposure: PEP even without obvious bite if suspicious
  • Domestic dog/cat/ferret: 10-day observation
  • Small rodents/rabbits: usually no PEP
  • Negri bodies in Purkinje cells = pathognomonic postmortem
  • WHO 2030: end dog-mediated rabies deaths
  • 盧醫垫 hint: 動物咬傷 + 旅遊 endemic + bat suspected → 立刻 PEP, don’t delay