Caring for patients with rabies in developing countries – the neglected importance of palliative care

Tarantola, Arnaud; Crabol, Yoann; Mahendra, Bangalore Jayakrishnappa; In, Sotheary; Hubert, Bernard; Bourhy, Hervé; Peng, Yiksing; Ly, Sowath; Buchy, Philippe

doi:10.1111/tmi.12670

Cited by 16 publications

(9 citation statements)

References 27 publications

(32 reference statements)

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“…Another five (16,22,(24)(25)(26) articles mentioned cancer, but not in isolation, they also pointed out other diseases such as diabetes, Alzheimer's disease, as well as respiratory and cardiovascular diseases. The expansion of PCs to other diseases appeared in a study on human rabies and suggested a review of clinical guidelines, proposing the introduction of PCs for people with rabies in endemic countries (31) .…”

Section: Discussionmentioning

confidence: 99%

Palliative care in primary health care: scoping review

Justino

Kasper

Santos

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to map the available evidence on the main topics investigated in palliative care in primary health care. Method: scoping review type study carried out in five databases, including original articles, based on the descriptors palliative care, palliative care at the end of life, terminal care, terminal state, primary health care and their respective acronyms and synonyms, totaling 18 publications. The extraction of data from primary studies was performed using an instrument produced by the authors and which allowed the construction of the categories presented. Results: 18 publications were included in this review. Among the most studied themes are the difficulties of the teams regarding the continuity of care in the health network; the importance of in-service education by the multidisciplinary team; professional unpreparedness; bioethics; the validation and application of scales for prognosis and care for some pathologies such as cancer and diabetes; among others. Conclusion: it became evident that palliative care in primary health care has been gradually developed, but it is necessary to consider the organization of primary health care and the social policies that support or weaken it, being considered a complex challenge.

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Section: Discussionmentioning

confidence: 99%

Palliative care in primary health care: scoping review

Justino

Kasper

Santos

et al. 2020

Rev. Latino-Am. Enfermagem

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“…Despite repeated attempts to treat rabies encephalitis, there is a lack of easily applicable palliative care protocol for rabies patients, which could be used in a developing country. Tarantola et al 18 recently published detailed suggestions on palliative treatment of rabies which could be used in a resource-limited setting. The authors explain palliative treatment of various symptoms of rabies, dosages of drugs, alternative routes of delivery, and also address nursing care concerns.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Failure of Therapeutic Coma in Rabies Encephalitis

Manesh

Mani

Pichamuthu

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Rabies encephalitis is a fulminant, almost universally fatal infection involving the central nervous system. A unique treatment protocol, including anti-exicitotoxic therapy and induced coma was credited with the survival of a vaccinated teenager with bat rabies encephalitis in 2005. However, multiple efforts to replicate this expensive and intense protocol have not been successful. In this article, we report the failure of the protocol in Indian patients with canine-acquired rabies and elucidate the potential explanations for the failure of the protocol in our patients.

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“…Although this is a fatal condition, it is important to avoid depressing respiration by giving the diazepam too rapidly by iv injection. Diazepam will alleviate the patient’s suffering, while giving the family time to adjust and consider the possibility of taking them home to die, if that is their personal or cultural preference [ 32 ]. This can be achieved by giving a slow injection (0.5 ml/min, which is 2.5 mg/min) of diazepam.…”

Section: Care Of Patients With Confirmed Rabies Encephalomyelitismentioning

confidence: 99%

The Imperative of Palliation in the Management of Rabies Encephalomyelitis

Warrell

Tarantola

2017

TropicalMed

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The aim of this review is to guide clinicians in the practical management of patients suffering from rabies encephalomyelitis. This condition is eminently preventable by modern post-exposure vaccination, but is virtually always fatal in unvaccinated people. In the absence of any proven effective antiviral or other treatment, palliative care is an imperative to minimise suffering. Suspicion of rabies encephalomyelitis depends on recognising the classic symptomatology and eliciting a history of exposure to a possibly rabid mammal. Potentially treatable differential diagnoses must be eliminated, notably other infective encephalopathies. Laboratory confirmation of suspected rabies is not usually possible in many endemic areas, but is essential for public health surveillance. In a disease as agonising and terrifying as rabies encephalomyelitis, alleviation of distressing symptoms is the primary concern and overriding responsibility of medical staff. Calm, quiet conditions should be created, allowing relatives to communicate with the dying patient in safety and privacy. Palliative management must address thirst and dehydration, fever, anxiety, fear, restlessness, agitation, seizures, hypersecretion, and pain. As the infection progresses, coma and respiratory, cardiovascular, neurological, endocrine, or gastrointestinal complications will eventually ensue. When the facilities exist, the possibility of intensive care may arise, but although some patients may survive, they will be left with severe neurological sequelae. Recovery from rabies is extremely rare, and heroic measures with intensive care should be considered only in patients who have been previously vaccinated, develop rabies antibody within the first week of illness, or were infected by an American bat rabies virus. However, in most cases, clinicians must have the courage to offer compassionate palliation whenever the diagnosis of rabies encephalomyelitis is inescapable.

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Caring for patients with rabies in developing countries – the neglected importance of palliative care

Cited by 16 publications

References 27 publications

Palliative care in primary health care: scoping review

Palliative care in primary health care: scoping review

Case Report: Failure of Therapeutic Coma in Rabies Encephalitis

The Imperative of Palliation in the Management of Rabies Encephalomyelitis

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