Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am 68 years old and six feet tall. I am a runner. I was bitten by a dog two and a half months ago. I have continuous agitation near the wrist where the dog bit. The agitation and muscular discomfort has radiated to the shoulders and down to the limbs. In addition, I have fatigue but no fever. I underwent multiple laboratory blood works but there was no infection. I am currently taking Amoxyclav 625 mg on and off for the past two months. I felt relieved after taking the pill and when I do not take the tablet the fatigue and pain returned. Also, Advil helps.
I was fine until I read on the internet regarding rabies and my symptoms mimic rabies. The dog has had its recommended shots and it is a healthy dog. However, I need some help sorting my symptoms, eliminating rabies, and help guide me. I have shared my encounter with the dog and its associated symptoms for your reference,
1. I have had a dog bite and developed a few symptoms that are persistent for more than two months and are concerning.
2. I had asked for shots at a local hospital and I was told I did not qualify.
3. The dog is unique because it is a young and strong hunting dog that lives on a ranch chasing down skunks, rats, and coyotes. The dog had his shots and is doing fine.
Rabies is widespread in my neighboring city and there are alerts. I am worried.
Please help me.
Hi,
Welcome to icliniq.com.
I went through your query and understood your concern.
It would have been ideal if you had taken rabies vaccine prophylaxis after the dog bite. Before we move further, I would like to know the following,
1. Did the dog bite lead to a wound, bleeding, or is the wound deeper?
2. What were the aseptic measures you took after the bite? Whether it was at a hospital ER (emergency room) or self-care at home? Please share the medical records and investigations done during this period.
3. Did this dog survive after biting?
4. Are you previously vaccinated with the rabies vaccine? If so, what dosages were taken at that time?
5. You mentioned that the dog was vaccinated. What is the source of that information?
According to the CDC (Centers for Disease Control and Prevention), USA (United States of America), rabies is a fatal but preventable viral disease that spreads to people and pets when bitten or scratched by a rabid animal. Rabies is primarily found in wild animals like bats, raccoons, skunks, and foxes. The virus primarily affects or infects the central nervous system. If a person does not receive the required medical treatment after a rabid animal bite, the virus can cause damage to the brain, leading to potential neural complications including mortality. The vaccination after bite exposure is a post-exposure prophylaxis (PEP) regimen, which varies from country to country. In Western countries, the PEP includes rabies vaccine at days 0, 3, 7, and 14 and Human rabies immunoglobulin (HRIG).
If you have been previously vaccinated, the risk is less, and you only need to take one dose of the vaccine. The manifestation of rabies in an unvaccinated person occurs after an incubation period from the time of exposure to the development of the symptoms. After rabies exposure, the rabies virus has to travel to the brain before causing symptoms. It may last for weeks to months. The incubation period may vary based on the exposure site, the type of rabies virus, and the immunity of the person.
I hope this has helped you.
Patient's Query
Hi doctor,
Thank you for your reply.
Here are my answers to your questions.
1. The dog remains healthy for the past three months and the owners are friends who keep meticulous records of vaccinations. The dog was vaccinated two years ago
2. The bite consisted of a lower tooth puncture and the upper tooth ripped my skin. I replaced the skin and applied Neosporin. I did not see a doctor until a tingling sensation and pain started in my arm one week after the bite.
3. After the bite I was given Amoxyclav 625 mg and a tetanus shot at the hospital ER. No rabies shot was given as the dog was vaccinated.
4. I never had the rabies vaccine.
5. The doctors did many blood tests which were negative for infections.
I will try to download the paperwork I left with the hospital last week after requesting vaccine shots. The dog is a German Shepherd type that chased coyotes, rats, skunks, and any other animal that may have come in contact. I noticed you have mentioned disease transmission because of scratches from animals and makes me wonder if there are any cases of vaccinated dogs passing rabies even though they do not get sick because they are protected. I will talk to my primary physician again this week and get you the paperwork.
Thank you.
Hi,
Welcome back to icliniq.com.
Thank you for your detailed reply.
Under these circumstances, it is unlikely for you to get the disease. However, I suggest that you get vaccinated right away even though it has been some time already. Even if the dog is vaccinated, the take-up of the vaccine and inducing immune response might be suboptimal. Hence as a precautionary measure, it is usually recommended to get the vaccine as per the scheduled dosage. The antibiotic recommended is fine, if you have taken it twice daily (625 mg per dose) for about five to seven days.
Kindly follow up with the hospital records.
Take care.
Patient's Query
Hello doctor,
Thank you for your response. I will work with my doctor on trying to get the shots for the vaccine for myself. Are there any other conditions that may cause this kind of symptoms of pain and muscle ache radiant radiating out from the bite area and moving slowly to all my limbs, head, and neck, general malaise, and the continued pain in leg muscles and soreness radiating up to the neck and hand and down into the back with possibly swollen knees? Can you think of any other viruses that could be transmitted from a dog bite that would cause any of these symptoms? We have treated heavily for infections and never found any infections in any of the blood work, but maybe there are infections that work differently and cause these kinds of symptoms that have lasted for three months. Let me know if there is anything that we could consider.
Also, would you have some key verbiage or words that could help us convince the emergency room that they should go ahead and give the vaccine shots to me? As you know, last week, they were reluctant and did not give me the shots. Now that my doctor is back, can he usually direct them to go ahead with the shots?
Hello,
Welcome back to icliniq.com.
Thanks for your revert. There are many bacterial and viral diseases transmitted by dogs to humans via infected saliva, aerosols, contaminated urine or feces, and direct contact with the dog.
1) Viral infections include rabies and norovirus.
2) Bacterial infections including Pasteurella, Salmonella, Brucella, Yersinia enterocolitica, Campylobacter, Capnocytophaga, Bordetella bronchiseptica, Coxiella burnetii, Leptospira, Staphylococcus intermedius and Methicillin resistance staphylococcus aureus.
CDC (Centers for Diseases Control and Prevention) provides a list of bacterial and viral infections transmitted as a zoonotic infection (dogs to humans) and basic preventive and treatment measures on its website. Rabies is the most rapidly fatal disease caused by a virus belonging to Rhabdoviridae. The incubation period varies between 4 days to several years, depending on the location of the inoculating wound and the number of induced viruses.
Patients may present agitation, anxiety, confusion, hallucination, and hydrophobia. Post-exposure prevention or postexposure prophylaxis (PEP) consists of a dose of human rabies immunoglobulin and rabies vaccine given on the day of the rabies exposure and then a dose of vaccine given again on days 3, 7, and 14. can prevent the disease. There is no time limit regarding the administration of PEP after exposure. In this case, it is still appropriate to initiate PEP. Administration of both human rabies immune globulin (HRIG) and four doses of rabies vaccine is recommended regardless of the time elapsed since the exposure.
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