Introduction

Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warmblooded animals including man. The virus is found in wild and some domestic animals, and is
transmitted to other animals and to humans through their saliva (i.e. following bites, scratches,
licks on broken skin and mucous membrane). Guidelines throughout worldwide quote that dogs
are responsible for about 97% of human rabies, followed by cats (2%), jackals, mongoose and
others (1%). The disease is mainly transmitted by the bite of a rabid dog. ( India,2013)
Rabies is caused by a neurotropic virus of the genus Lyssavirus. This genus includes the classic
rabies virus, two European bat lyssaviruses, an Australian bat lyssavirus, and the African
Duvenhage virus. (N Mckay, 2005) There were 104 human rabies cases in Bali during November 2008November 2010. Patients mean age was 36.6 years (range 3-84 years; SD 20.7), most were male
(56.7%), and originated from rural districts. Almost all (92%) cases had a history of dog bite.

( Ni

M Susilawathi, 2012)

Rabies is an infection initially of wild and now domestic animals, which is spread to humans by
bites, contact with mucosal membranes. Most infections (90%) are transmitted via domestic
animals (cats and dogs), mainly due to their closer association with humans. After a bite, the
virus replicates in muscle cells close to the site of the bite and then ascends to the central nervous
system via the peripheral nerves. From the central nervous system, there is viral replication on
membranes within neurons and then transmitted directly across synapses into efferent nerves,
and is deposited in almost every body tissue, including the autonomic nervous system via neural
pathways. The incubation period from bite to disease varies widely, but is usually between 30
and 90 days. Bites on the head and neck have a shorter incubation period (sometimes even as
short as 15 days) compared with those on the trunk and lower extremities, due to the decreased
length and greater number of neurones. (N Mckay,2005)
After a rabies virus transmission , the prodromal symptoms that emerge are itching, pain, or
parasthesia at site of bite wound, fever, myalgia, headache, irritability or depression,
gastrointestinal upset, radiculopathy in bitten limb, also proceeding to encephalopathy. The
prodromal symptoms will later proceed to either furious or paralytic rabies. Furious rabies

includes presentations such as irritability, agitation, hydrophobia and hyperesthesia. While

paralytic rabies develops a flaccid paralysis. (N Mckay,2005)
Thus, development of rabies can be prevented to a large extent if animal bites are managed
appropriately and in time. (India,2013)