2017
DOI: 10.3390/tropicalmed2040052
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The Imperative of Palliation in the Management of Rabies Encephalomyelitis

Abstract: 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 pos… Show more

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Cited by 21 publications
(19 citation statements)
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“…Though recovery from rabies is consistently associated with the presence of neutralising antibodies in the blood and CSF, family members of previously vaccinated patients diagnosed with rabies must be made aware that although intensive care can prolong life, the patient is most likely to survive with multiple disabilities. These cases also underscore the urgent need for formulation of national guidelines for management of rabies cases in rabies endemic countries and the imperative of humane palliative care to minimize the suffering of those dying of this agonizing disease [32].…”
Section: Discussionmentioning
confidence: 99%
“…Though recovery from rabies is consistently associated with the presence of neutralising antibodies in the blood and CSF, family members of previously vaccinated patients diagnosed with rabies must be made aware that although intensive care can prolong life, the patient is most likely to survive with multiple disabilities. These cases also underscore the urgent need for formulation of national guidelines for management of rabies cases in rabies endemic countries and the imperative of humane palliative care to minimize the suffering of those dying of this agonizing disease [32].…”
Section: Discussionmentioning
confidence: 99%
“…Many patients develop phobias that will likely require seclusion in a calm, quiet room. Although there is little to no evidence of human-to-human transmission, visitors and medical professionals need to be cautious of potential contamination via the patient's secretion [61]. Dehydration is a major concern as paralytic rabies often inhibits the patient's ability to swallow and furious rabies can cause intense hydrophobia.…”
Section: Palliative Carementioning
confidence: 99%
“…However, these have not been studied specifically for a rabies-induced central fever and so practitioners should be mindful of potential side effects. Additionally, these drugs are rarely available in the developing countries where RABV is most prevalent [61]. In this case, external, physical means of cooling the patient can be used as needed.…”
Section: Palliative Carementioning
confidence: 99%
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“…Finally, Warrell et al [ 25 ] can be understood in a similar context as the issue discussion began—rabies can be prevented by rapid and appropriate postexposure prophylaxis, but retains the title as the entity with the highest case fatality. As such, once clinical signs manifest, frustration and futility ensue for all involved.…”
mentioning
confidence: 99%