Chapter 15
1. If Steven had been aware that he was bitten, disinfection of the wound and prompt
medical attention could have saved him. If they had been sufficiently informed, Steven
and Michael might have surmised from the bat’s behavior that it was sick. Whenever
there is contact between a bat and a sleeping person or any possibility of a bat bite even
if the bite is not evident, it is advisable to get post-exposure prophylaxis (PEP) against
rabies.
2. Steven is in the prodromal phase. By this time, the rabies virus has already invaded the
CNS and there is nothing that can be done to save a patient’s life even if the disease is
diagnosed early. PEP could be attempted, but only one person has ever survived rabies
after the onset of symptoms, even with treatment, and that case is questionable.
3. The rabies virus travels slowly up the peripheral nerves to the CNS. It has a longer
journey to make from nerves of the limbs, especially the lower limbs, than it does from
nerves of the trunk, head, and neck. When traveling from a bite on the lower limb, it
therefore takes longer for the virus to invade the CNS and begin causing symptoms.
4. As this and several real case studies show, some tissue and fluid samples can be
negative while others are positive. It is therefore unsafe to base a diagnosis on only one
type of sample. Steven’s nuchal skin biopsy was a skin shaving from the back of the
neck (nuchal region).
5. As discussed in chapter 12 of this manual, gardening, farming, and other work in the soil
present a risk of tetanus because the bacterial spores are present in soil and a person
often incurs small nicks and cuts that create a risk of infection. Steven’s job and his
spastic muscle contractions lead to a suspicion of tetanus.
6. No, the organs of a person who dies of rabies are unsafe for transplant. As remarked
before the case study, some people have died of rabies contracted from corneal
transplants from infected donors.
7. Both of these disorders are characterized by clonic muscle contractions, but rabies lacks
the massive neuronal discharge, seen in electroencephalograms, that are characteristic
of grand mal epilepsy.
8. The rooting reflex helps a baby orient its mouth and grasp a nipple so that it can nurse.
9. Paresthesia refers to abnormal sensations such as tingling or burning in the absence of
external stimulation, as opposed to reduced sensitivity to stimuli that really are present.
10. (d) Low back pain could result from any of the listed conditions except hyporeflexia.