Caring for patients with rabies in developing countries - the neglected importance of palliative care.

Arnaud Tarantola (1) , Yoann Cabrol (1) , Bangalore Jayakrishnappa Mahendra (2) , Sotheary In (1) , Hubert Barennes (1) , Hervé Bourhy (3) , Yiksing Peng (1) , Sowath Ly (1) , Philippe Buchy (4, 5)

1 Unité d'Épidémiologie et de Santé Publique [Phnom Penh]
2 Kodagu Institute of Medical Sciences
3 CC-OMS - Centre Collaborateur de l'OMS pour la Rage - Dynamique des lyssavirus et adaptation à l'hôte
4 Unité de Virologie / Virology Unit [Phnom Penh]
5 GlaxoSmithKline

Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries.

Mots clés: hydrophobie; midazolam; pays en voie de développement; palliative care; países en vías de desarrollo; hidrofobia; diazépam; soins palliatifs; traitement; treatment; tratamiento; cuidados paliativos; developing countries; Rabia; hydrophobia; rabies; rage

Domaines: Sciences du Vivant [q-bio]; Maladies infectieuses

Arnaud Tarantola, Yoann Cabrol, Bangalore Jayakrishnappa Mahendra, Sotheary In, Hubert Barennes, et al.. Caring for patients with rabies in developing countries - the neglected importance of palliative care.. Tropical Medicine and International Health, 2016, 21 (4), pp.564-7. ⟨10.1111/tmi.12670⟩. ⟨pasteur-01429841⟩