Rabies and Immunoglobulin Service (RIgS), UK Health Security: 0330 128 1020

	Almost always fatal - death from respiratory paralysis
Etiology	Lyssavirus. In UK, detected in bats.
Epidemiology	any mammal can transmit.
Clinical presentation	- Incubation: 3-12 weeks, but as long as YEARS. ("93% of patients - onset within 1 year of exposure") - paraesthesiae around the site of the wound, fever, headache and malaise - Encephalomyelitis
Pathogenesis
Diagnostic investigations
Management	Wash and disinfect wound e.g. povidone iodine, 70% ethanol etc. Avoid wound closure until post-exposure prophylaxis has been given
Prevention

higher risk bites/wounds

depending on individual country risk profile specific to the animal: https://www.gov.uk/government/publications/rabies-risks-by-country
- bats are always high risk
animal with abnormal behaviour (but does not rule out)
unprovoked bites
unvaccinated animal (though rarely vaccinated animals have transmitted rabies)
domestic animals should be observed for 15 days after bite for abnormal behaviour
Broken skin - single or multiple transdermal bites, severe lacerations, or where mucous membranes or an existing skin lesion have been contaminated by the animal’s saliva or other body fluid.
- Intact skin is a barrier against infection
- bat bites in the UK may not be visible

are you scared now?!