Rabies treatment

Stuart G, Krikorian KS. The neuroparalytic accidents of anti-rabies treatment. Ann Trop Med Parasitol 1928 22 327-77. 

If a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis (if indicated), and immunization. Postexposure prophylaxis immunization consists of both passive antibody administration and vaccine administration. 

Treatment involves the application of rabies-specific antibodies that are infiltrated around the bite wound, in addition to immunization. The antibodies provide passive protection and are able to neutralize the virus. For developing countries, these antibodies are both too expensive and difficult to produce in large quantities. In addition to this, there is a dramatic shortage of rabies monoclonal antibodies (MAbs) available on a worldwide basis. The production of inexpensive and safe plant-derived MAbs would be useful in postexposure prophylaxis-global health benefit. 

Commonly known as treatment for dog bite. Rabies is usually caused by the bite of infected dog, monkey, cat, etc. and can lead to hydrophobia (feeling of fear of water) and death. A series of five injections need to be given. Usually rabies vaccine is given once the dog bite has already taken place. 

Sir William Brooke O Shaughnessy introduced Indian hemp to the West in 1839. William Brooke O Shaughnessy entered the service of the East India Company in 1833 as assistant surgeon. He studied the botany and chemistry of herbs used in oriental medicine and incorporated some into his edition of the Bengal Pharmacopoeia published in 1842. One of these herbs was cannabis, or Indian hemp. His medical treatise recommended an extract from the plant for patients with rabies, cholera, tetanus, and infantile convulsions. Until the end of the 19th century prominent physicians of Europe and North America advocated cannabis extracts for the prevention and symptomatic treatment of migraine headache. 

Pre-1900 Treatment of rabies, anthrax, and smallpox Principles of infection control and pain relief Management of heart failure... 

Stone PH, Gibson RS, Glasser SP, DeWood MA, Parker JD, Kawanishi DT, Crawford MH, Messineo FC, Shook TL, Raby K, et al. Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group. Circulation 1990 82(6) 1962-72. 

A 14-year-old boy had a seizure after the administration of human diploid rabies cell vaccine simultaneously with rabies immune globulin. The sjmptoms developed within minutes after injection. After treatment and about 2 hours later, his mental status returned to normal (6). 

Mortiere MD, Falcone AL, Plotkin SA, Loupi E, Lang J. An acute neurologic syndrome temporally associated with postexposure treatment of rabies. Pediatrics 1997 100(4) 718-21. 

The capacity to make these patients euphoric led him next to try to alleviate the terrible symptoms associated with rabies in one of his patients. Although the man soon died of the disease, O Shaughnessy was intrigued to find that the drag did relieve some of the patient s agony and did enable him to swallow some juice and moistened rice. O Shaughnessy also experimented with cannabis in the treatment of cholera, tetanus, and epilepsy, reporting that in all cases his patients experienced relief from the symptoms of these disorders. 

The first group presents within 12 hours of the injury these patients require general wound care, repair of tear wounds, or rabies and/or tetanus treatment. 

After a patient has been exposed to rabies, the treatment objectives consist of thorough irrigation of the wound, tetanus prophylaxis, antibiotic prophylaxis, if indicated, and immunization. Prompt, thorough irrigation of the wound with soap or iodine solution may reduce the development of rabies. Postexposure prophylaxis immunization consists of the administration of both passive antibody and vaccine. The only exceptions to antibody administration are patients who have been immunized previously and have the appropriate degree of documented rabies antibody titers. 

Wilde H, Sirikawin S, Sabcharoen A, et al. Failure of postexposure treatment of rabies in children. Clin Infect Dis 1996 22 228-232. 

These days, the vaccine is produced using cultures of human cells in which the virus is grown and then attenuated, by heat treatment or with chemicals. Although there is little need for the vaccine in Europe, rabies is still a major problem in Russia, Africa, China, Japan, and the USA. In India, the disease... 

Bringing matters somewhat more up to date, it may be mentioned that the Papago Indians of the American Southwest and northwestern Mexico were reported by Joseph G. Lee, M.D., to have a rabies cure. The cure, interestingly, also involved rue. Thus, Dr. Lee, in an article titled Navajo Medicine Man in the August 1961 issue of Arizona Highways, describes rue as a Navajo remedy for rabies. Another is said to be dog lichen, Peltigear canina, which received its name as a folkloric cure for rabies. Nevertheless, most of us would no doubt prefer a modem version of the Pasteur treatment. 

Lastly, it may be mentioned that bats are apparently the only mammals that can survive the rabies virus. Although other animals such as skunks are carriers, the rabid populations eventually die out. Such is not the case with bats, as a few cave explorers have inadvertently found out. This sort of viral immunity may ultimately have application in cancer prevention and treatment. 

The extension is to the introduction of microorganisms and their toxins to stimulate the immime system as per Coley s Toxins. From there, the extrapolation is to the use of vaccines or serums, as per the Pasteur treatment for rabies. The ultimate goal is preventive inoculation, as for poUo.)... 

George Bernard Shaw s comments about vaccines, particularly the Pasteur treatment, which emphasizes that not everyone bitten by a rabid animal connacts rabies. (Nevertheless, who wants to play the odds Further, the rabies virus may he dormant, with the disease only showing up later, or many years later, as pointed out by Colin Kaplan et al., 1986, in Rabies The Facts)... 

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