RABIES

CAUSES/SOURCES:
The most frequent way to contract rabies is through being bitten by a rabid animal, or an animal
that has the rabies virus. The virus can enter the body through an opening in the skin, such as a
bite wound, and is carried in the saliva of the rabid animal. Although it is possible to contract
rabies without being bitten, this is extremely uncommon. For instance, non-bite exposures can
occur when a rabid animal licks a person's eyes, nose, mouth, or damaged skin, or they can
occur when the virus is inhaled as aerosol particles.

Animals at high risk include:

 Racoons and bats
 Skunks and foxes
 woodchucks
 (Wild) canines that are not domesticated

It is essential to vaccinate domestic animals like cats, dogs, and cattle against rabies since
these animals are susceptible to contracting the disease if they are bitten by another animal that
has the virus. Some nations have recently started taking action to immunize wildlife populations
using oral baits that include vaccines. This is drastically decreasing the transmission of the
disease to populations of animals kept as pets or livestock.

PATHOGENESIS:
The most typical way that the rabies virus is spread is by the bite of an infected mammal,
though any species may be susceptible to variable degrees. The virus can reproduce in muscle
tissue after infecting the host or it can enter the peripheral nervous system directly. In either
case, it stays at or close to the introduction site for the majority of the incubation period.
However, as neither antigen nor virus are typically present in any organ during this stage, the
precise locations of viral sequestration remain unknown.

The virus may penetrate the neuromuscular connections of the peripheral nervous system and
travel quickly centripetally to the central nervous system for replication before exhibiting
symptoms. Following then, the virus starts to spread centrifugally to several tissues and organs,
including the salivary glands.

Meningeal vessel congestion is typically visible on a visual examination of the brain; on

microscopic analysis, however, acidophilic intracytoplasmic neuronal inclusions, minimal tissue
necrosis, and neuronophagia are frequently seen.

SIGNS/SX (SYMPTOM):

The rabies virus must first reach the brain following an exposure before it may start to produce
symptoms. The incubation period is the span of time between exposure and the onset of
symptoms. That could continue for weeks or months. Based on, the incubation period may
change. Depending one:
 The type of rabies virus.
 The location of the exposure site (the distance from the brain).
 Any prior immunity.
The initial signs of rabies, such as weakness or pain, fever, or headache, may resemble those
of the flu. Moreover, there can be pain, prickling, or an itchy sensation where the creature bit
you. The signs could persist for several days.

The symptoms then intensify to include agitation, anxiety, confusion, and brain malfunction. The
person may have delirium, bizarre behavior, hallucinations, hydrophobia (fear of water), and
insomnia as the illness worsens. Usually, the disease's acute phase lasts between two and ten
days. The disease is almost usually fatal once clinical symptoms of rabies manifest, and
treatment is typically supportive. Less than 20 human cases of clinical rabies survival have been
recorded. The majority of survivors had taken pre- or postexposure prophylaxis in the past.

The symptoms, indications, and prognosis of rabies in animals can differ. In many cases, the
symptoms that manifest in animals are comparable to those that manifest in humans. Early
nonspecific signs, immediate neurologic problems, and ultimately mortality are some of them.

DX (DIAGNOSIS):
The direct fluorescent antibody test, often known as the DFA test, is used to diagnose rabies in
animals. This test searches for the presence of rabies viral antigens in brain tissue. With human
subjects, a variety of tests will need to be conducted.

To administer postexposure prophylaxis in a timely manner, rabies in people and other animals
must be quickly and accurately diagnosed in the laboratory. A diagnostic lab can ascertain
whether or not an animal is rabid in a matter of hours and can then alert the relevant medical
staff. If the animal is not rabid, the test findings may spare the patient from needless physical,
psychological, and financial suffering.

Moreover, characterizing existing epidemiologic patterns of disease and providing pertinent data
for the creation of rabies control strategies may be aided by laboratory detection of positive
rabies cases. Due to the nature of the rabies virus, laboratory testing must be standardized,
quick, sensitive, specific, affordable, and dependable.

TX (TREATMENT):
There is no cure for rabies once symptoms appear. Due to this, medical professionals
emphasize prevention and work to avoid the disease as soon as a person is exposed. Everyone
who has even the slightest suspicion that they may have been exposed to the rabies virus must
seek immediate medical attention.

As quickly as feasible, doctors administer two shots:

 Rabies Immune Globulin: This offers protection before the vaccination even begins to
operate.
 Rabies Vaccine: This is administered in a schedule of four doses, starting on day 0 and
continuing on days 3, 7, and 14. (day 0 is the day of the first dose). An additional dose is
given on day 28 to those with compromised immune systems.

Rupprecht, C. E. (1996). Rhabdoviruses: Rabies Virus. Medical Microbiology - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK8618/#:~:text=Pathogenesis,nervous%20system
%20invasion%20and%20replication.
What are the signs and symptoms of rabies?    | Symptoms | CDC. (n.d.).
https://www.cdc.gov/rabies/symptoms/index.html?
fbclid=IwAR1hlCx1MMu3fzqoFXzW5WD_7dFiY9cWIXphspiIzNCppg92cKl4RLn7GhM

RUBELLA
CAUSES/SOURCES:
Rubella is an infectious disease that is caused by a virus that can be spread from one person to
another. It is possible for it to be passed from person to person when an infected person coughs
or sneezes. Moreover, it can be transferred by direct contact with contaminated nasal and throat
mucus. In addition, it has the potential to be transmitted through the bloodstream of pregnant
women to their unborn offspring.

A person who has been exposed to the rubella virus is infectious for about a week before the
rash emerges and for another week after the rash has subsided. Before becoming aware of
their infection, an infected person can transmit the disease.

Because the vast majority of children in many countries receive vaccinations against rubella at a
young age, the disease is quite uncommon. The virus is still active in several regions of the
world. When traveling abroad, you should think about this, especially if you're expecting.
Broadly speaking, once you've encountered the illness, you're immune permanently.

PATHOGENESIS:
The only known reservoir of the rubella virus is a human, and postnatal person-to-person
transmission happens when an infected individual comes into direct or droplet contact with
another person's respiratory secretions. Although the initial stages of infection are not fully
understood, it is almost evident that the virus multiplies in respiratory tract cells, spreads to
nearby lymph nodes, and subsequently engages in viremic dissemination to target organs. A
secondary viremia with widespread distribution of the rubella virus results from further
replication in particular target organs, such as the spleen and lymph nodes. During this stage,
the virus can be found in the blood and respiratory secretions (about 7 days after infection and 7
to 10 days before the appearance of rash). After the formation of the rash, viremia diminishes
quickly. It is also connected to the emergence of circulating neutralizing antibodies. But even
once the rash starts to appear, viral shedding from the respiratory tract can last up to 28 days.

When rubella is contracted during the first three to four months of pregnancy, there is a chance
for placental invasion and subsequent fetal infection. The gestational age undoubtedly affects
how an infection develops. According to estimates, if the mother contracts rubella during the first
two months of pregnancy, the fetus has a 40 to 60 percent chance of developing multiple
rubella-associated defects, with the risk decreasing to 30 to 35 percent during the third month of
pregnancy and 10 percent during the fourth. This variation in fetal infection risk and severity with
gestational age may be due to underdeveloped host defenses during the first trimester of
pregnancy.

Virtually any organ system can become infected during pregnancy and experience viral
replication and harm. Congenital abnormalities' pathogenesis is not entirely known; however, a
number of pathways have been suggested. Studies on the virus' effects in cell culture reveal
that it causes chromosomal abnormalities, reduces cellular growth rates, and results in cell lysis
and death in some cell types; these effects appear capable of creating the typical defects of cell
structure and function. Moreover, rubella infection causes angiopathy of early placental and
embryonic tissues, interfering with the fetus's blood supply and ultimately impairing its growth
and/or resulting in deformity. Virus persistence occurs in the presence of neutralizing antibodies
in the congenitally infected fetus and newborn; immunological tolerance does not develop.

SIGNS/SX (SYMPTOM):
Children typically only experience a few mild symptoms of rubella. A red rash is frequently the
first indication in kids who do exhibit symptoms. The rash typically starts on the face, moves to
the rest of the body, and disappears after three days. One to five days before the rash develops,
there may also be additional symptoms, such as:

headache with a low-grade temperature

slight pink eye (redness or swelling of the white of the eye)
overall discomfort enlarged and swollen lymph nodes
runny nose and cough
The majority of adults who have rubella often experience a minor sickness, including a sore
throat, low-grade fever, and a rash that begins on the face and spreads to the rest of the body.

Prior to the rash developing, some individuals may also have a headache, pink eye, and general
discomfort.

It's estimated that between 25 and 50 percent of persons who have rubella won't show any
symptoms at all.

DX (DIAGNOSIS):
In order to determine whether or not you have rubella, your doctor will perform a physical
checkup on you and examine your rash, if you have one. They may check your blood, urine, or
mucus from your throat or nose for rubella symptoms.

A diagnosis of rubella can be made by the use of the following tests:

 A Blood Test. Your healthcare professional will use a tiny needle to draw a little sample
of blood from your arm. They'll check for antibodies to rubella, which would indicate that
you are now ill, have previously had rubella, or have received a rubella vaccination.
 Swabs of the Nose or Throat. Your healthcare professional will take a sample from
your nose or throat using a soft-tipped stick (swab). The sample will be examined in a
lab for rubella symptoms.
 Urine Examinations. You'll urinate into a clean cup. Your urine will be examined in a lab
for indications of rubella.

TX (TREATMENT):
For the treatment of rubella, there is no particular medication. In most cases, it gets better on its
own. Symptoms may be managed at home using over-the-counter drugs. To stop the spread of
rubella, your doctor could advise quarantining you away from other people.

Most of the time, over-the-counter medications like acetaminophen (commonly referred to as

paracetamol and sold under the brand names Tylenol® or Panadol®) or cough and cold
remedies can be used to treat rubella symptoms at home. The ideal strategy to address your
symptoms should be discussed with your healthcare professional. Before administering drugs to
your child for rubella, you should first consult with their pediatrician.
The severity of congenital rubella syndrome affects the treatment options. Surgery or
prescription drugs can be used to address some disorders. Some damage is irreversible, and
the only way to enhance quality of life is to manage the illness.

Also, inoculation with the MMR vaccine is the most effective strategy to avoid rubella. It has a
97% success rate in stopping rubella infection. In other words, three or fewer of every 100
properly immunized individuals will contract rubella. You can immunize against rubella as an
adult or child.

The MMR or MMRV vaccines are both options for rubella vaccination.

MMR vaccination. The MMR vaccine offers defense against rubella, mumps, and measles.
Everyone who is at least 12 months old can receive the MMR shot.
MMRV vaccination. Measles, mumps, rubella, and chickenpox are all diseases that are
prevented by the MMRV vaccine (varicella). Only kids between the ages of 12 months and 24
months are eligible for the MMRV immunization.

If you want to get pregnant, you should get vaccinated against rubella or have a test for rubella
antibodies at least one month beforehand.

Other means of preventing rubella include:

 Regularly wash your hands, especially if you're unwell.
 Never let anyone else use your personal goods, such as cups or cutlery.
 When you cough or sneeze, cover your mouth and nose.
 When traveling, be aware of if rubella or other infectious diseases are more prevalent
where you are going.

Parkman, P. D. (1996b). Togaviruses: Rubella Virus. Medical Microbiology - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK8200/

Rubella - Symptoms and causes - Mayo Clinic. (2022, May 11). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/rubella/symptoms-causes/syc-20377310

Rubella (German Measles): Symptoms, Treatment & Prevention. (n.d.). Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17798-rubella