Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Should people get a pre-exposure vaccination before traveling outside the U.S.?
The CDC suggests people consider pre-exposure vaccination for rabies if (1)
planned activity will bring you into contact with wild or domestic animals, for
example if
you are a biologist, veterinarian, or agriculture specialist working
with animals,
you will visit remote areas where medical care is difficult to
obtain or may be delayed, for example, hiking through remote villages where dogs
are common,
or your stay is longer than one month in an area where dog rabies is
common. The longer your stay, the greater the chance of an encounter with an
animal.
Pre-exposure vaccination consists of the treatment schedule presented in
the prevention section of the article, except that the rabies immune globulin
shot in not given.
What is the prognosis for people with rabies?
People who are treated early and appropriately when exposed to rabies have
an excellent prognosis. As stated previously, no one who has begun this
treatment within 48 hours of exposure and has followed it appropriately has ever
developed a fatal case of rabies in the U.S. Some individuals with a debilitated
immune system (for example, HIV or cancer patients) may require additional
treatment and monitoring. An infectious-disease consultant should be consulted
to optimize treatment and prognosis. Although some investigators report some
treatment success in patients treated beyond 48 hours, the longer the delay in
treatment, the more likely the person will develop a fatal infection due to
rabies virus.
Unfortunately, untreated or inappropriately treated rabies is almost always
fatal. Although heroic efforts have been attempted to save patients, success is
very rare. Death usually occurs in about seven days from respiratory failure
after the more severe rabies symptoms develop.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
There are millions of dogs living in the United States, and thus many cases of dog bites. Annually, hundreds of people seek emergency medical care for dog bites. Treatment for a dog bite depends on how deep the injury is and the amount of tissue damage. Dog bites can be prevented by employing preventative measures.
Tetanus is an often-fatal disease caused by nerve toxins produced by the common bacteria Clostridium tetani. In a seven-day period after infection, a person experiences muscle spasms, restlessness, headache, irritability, then lockjaw, and the lungs stop functioning. Tetanus is treatable with antibiotics and drainage. Sedation is often give to stop muscle spasms.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
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