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  #1  
Old 12-06-2011
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Question A bat in the bedroom!

An 85-year-old man is brought to the office by his daughter the same day that she discovered a bat in his bedroom. The bat was not noticed the night before and flew out the window this morning. The man is not aware of any bite.
On physical examination, his vital signs are normal. His skin shows no evidence of a bite, scratch, or puncture wound. Neurologic examination is normal.
Which of the following is the most appropriate prophylaxis for this patient?
( A ) Give rabies immune globulin only if he begins to behave abnormally
( B ) Give rabies immune globulin now
( C ) Begin a rabies vaccine series now
( D ) Give rabies immune globulin and begin a rabies vaccine series now
( E ) No prophylaxis is required
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Old 12-06-2011
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Since there is no evidence of a bite, scratch, or puncture wound. I would go with E.
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Old 12-06-2011
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I will go with D. Give rabies immune globulin and begin a rabies vaccine series now....even though there is no signs of bite, wound or scratch, the profilaxis should be with both Ig and vaccine series; the reason is that, once the rabies have clinical signs, it is almost universal deadly.....

General speaking, any contact with a bat should get rabies profilaxis with the next management:

1. a person never vaccinated against rabies or with an unknown vaccination history, should get both Ig and vaccine series(I hope I remember well: there are a 3 shots given now, them after 1 month and then the last one given at 6 month....I hope I'm not wrong about timing)
2. a person who was recently vaccinated(these are the persons at high risk like cave explorers, veterinarians, etc) and got in contact with bats should get only the vaccine series even if the previously vaccine was one year ago(answer C).

I hope this helps....good luck!
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Old 12-06-2011
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I'm going to go with D as well, because during my Live Kaplan Lectures we were taught that even in the presence of a habitat of a bat or in this case entering the bedroom and leaving will leave traces. Basically seeing Batman means you got his rabies.

Quote:
Originally Posted by anatomie View Post
I will go with D. Give rabies immune globulin and begin a rabies vaccine series now....even though there is no signs of bite, wound or scratch, the profilaxis should be with both Ig and vaccine series; the reason is that, once the rabies have clinical signs, it is almost universal deadly.....

General speaking, any contact with a bat should get rabies profilaxis with the next management:

1. a person never vaccinated against rabies or with an unknown vaccination history, should get both Ig and vaccine series(I hope I remember well: there are a 3 shots given now, them after 1 month and then the last one given at 6 month....I hope I'm not wrong about timing)
2. a person who was recently vaccinated(these are the persons at high risk like cave explorers, veterinarians, etc) and got in contact with bats should get only the vaccine series even if the previously vaccine was one year ago(answer C).

I hope this helps....good luck!
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  #5  
Old 12-06-2011
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Thumbs Up the answer is D but for building up concepts please click on the following link

1. http://www.health.state.mn.us/divs/i...isk/table3.pdf
2.http://www.health.state.mn.us/divs/i...texposure.html
3. http://www.health.state.mn.us/divs/i.../humanbat.html
4.http://www.nj.gov/health/cd/document...Guide.pdf(read the 4th point which mentions " Is the bat, raccoon, skunk, fox or groundhog available for laboratory examination"
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Old 12-06-2011
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( E ) No prophylaxis is required
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All of you are right, even if there are no bite marks you would treat with the immuno and the vaccine.

Now suupose a young boy is bitten by a dog in the USA how would you treat, would you give vaccines,Iglobulin or nothing????

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Old 12-06-2011
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Quote:
Originally Posted by indigo View Post
All of you are right, even if there are no bite marks you would treat with the immuno and the vaccine.

Now suupose a young boy is bitten by a dog in the USA how would you treat, would you give vaccines,Iglobulin or nothing????

i guess we do the same even the dogs r not the first carrier of Rabis
but why taking chances??
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Old 12-06-2011
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Quote:
Originally Posted by dr.muhamad View Post
i guess we do the same even the dogs r not the first carrier of Rabis
but why taking chances??
same procedure, plus antibiotics, remember the micro pathogen that causes cellulitis in dog bites... Pasteurella multocida.
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Quote:
Originally Posted by indigo View Post
All of you are right, even if there are no bite marks you would treat with the immuno and the vaccine.

Now suupose a young boy is bitten by a dog in the USA how would you treat, would you give vaccines,Iglobulin or nothing????


depends very much on the dog history of vaccination, if the dog was provoced or not, if the dog shows any sighs of rabies, if the dog can be cought and kept under surveilance, if the dog recently born new babies, etc etc......
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Quote:
Originally Posted by anatomie View Post
depends very much on the dog history of vaccination, if the dog was provoced or not, if the dog shows any sighs of rabies, if the dog can be cought and kept under surveilance, if the dog recently born new babies, etc etc......
It depends on the vaccination of the dog
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Old 12-06-2011
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It depends on whether or not the dog is owned or stray. Vaccinated or Wild. and economic status.
Quote:
Originally Posted by indigo View Post
It depends on the vaccination of the dog
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Old 12-06-2011
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( D ) Give rabies immune globulin and begin a rabies vaccine series now

Rabies vaccination should be done for veterinarian handlers, cave explorers ,lab workers handling infected tissues and those living in developing countries where rabid animals ( may be dogs ) are prevalent.
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