Andi Kurnia Bintang, Muhammad Iqbal Basri, Mimi Lotisna, Michael Carrey

Rabies: Diagnostic, Treatment, and Prevention

Introduction

Rabies: diagnostic, treatment, and prevention. Understand rabies: a fatal neurological disease spread by animals. Learn about its diagnosis (clinical, imaging), treatment (vaccines, antivirals), and crucial prevention strategies.

Abstract

Rabies is a neurological disease with fatal impacts because it has a high mortality rate. Animals, primarily dogs, mediate the spread of rabies. Clinical findings of rabies are divided into two categories: classic rabies (furious type) and paralytic type. Furious rabies has many cardinal features, such as fluctuating consciousness, aerophobia or hydrophobia, inspiratory spasm, and autonomic dysfunction. Ascending paralysis with a lower motor neuron lesion is the initial sign of paralytic rabies. The rabies virus invades and lives in neurons. It is virulent. Besides clinical findings, the diagnostic approach can involve radiology, microbiology, and histopathology. There are not only symptomatic treatments for rabies patients but also vaccines, immunoglobulin, and antivirals to decrease the progressivity of the disease. Vaccination programs and animal control have become essential in reducing rabies cases in Indonesia.

Review

The manuscript, "Rabies: Diagnostic, Treatment, and Prevention," offers a comprehensive, albeit concise, overview of a critical global health concern. It effectively introduces rabies as a devastating neurological disease characterized by its high mortality rate and zoonotic transmission, primarily through dog bites. The chosen scope, covering diagnosis, treatment, and prevention, is highly relevant and addresses the fundamental aspects necessary for understanding and combating this public health threat. This broad approach makes the paper valuable for a diverse audience, from clinicians to public health practitioners. A notable strength of this paper, as indicated by the abstract, is its clear differentiation between the furious and paralytic forms of rabies, delineating their distinct clinical presentations. This clarity is crucial for timely and accurate clinical diagnosis. The abstract also highlights a comprehensive diagnostic strategy, extending beyond clinical findings to encompass radiological, microbiological, and histopathological approaches. Furthermore, the paper promises to cover a spectrum of interventions, from symptomatic management and post-exposure prophylaxis (vaccines, immunoglobulin) to the potential role of antivirals. The inclusion of preventive measures, specifically mentioning vaccination programs and animal control initiatives in Indonesia, adds a practical and geographically relevant dimension to the discussion. While providing a solid foundation, the abstract suggests areas where the full paper could be further enhanced for a deeper impact. Regarding treatment, a more nuanced discussion on the limitations of current symptomatic care for established rabies and the current evidence base (or lack thereof) for antivirals in *post-symptomatic* disease would be highly beneficial. Similarly, for diagnostic methods, elaborating on the sensitivity, specificity, and practical applicability of each technique in different settings could strengthen the diagnostic section. Finally, given the specific mention of Indonesia, a deeper exploration into the challenges, successes, and socio-economic factors influencing rabies control programs in that region would significantly enrich the prevention discussion, moving beyond a descriptive listing to offer critical insights and potentially inform future strategies.

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