Infectious disease Archives - Jeffrey Sterling, MD

You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.

Bites from these animals are regarded as rabid unless proven otherwise by lab tests. These animals must be killed and tested as soon as possible.

Animals that have been reported to transmit rabies include dogs, cats and ferrets.

If bitten from these animals, and it appears rabid, treatment must begin immediately.
If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.

Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?

Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
Make every effort to secure the animal.
Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.

What can you expect?

Vigorous wound cleaning
Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
Additional vaccination for tetanus, if appropriate
Antibiotics if appropriate.

Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles. However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus. It’s rather benign.
hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii). If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease. This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

And yes, secondary syphilis presents with rashes on the palms and soles. The real take home message is this. Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed. Trust me, you want to get treated before tertiary syphilis develops. Here’s what that rash looks like.

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.

Tag Archives: Infectious disease

Straight, No Chaser: Emergency Room Adventures – The Risk of Rabies

Straight, No Chaser: Quick Tips – Rashes on Your Palms and Soles – Pay Attention!