title: Caring for patients with rabies in developing countries - the neglected importance of palliative care.
abstract: 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.
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.|Rabies Prevention Center, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Crabol
authors.affiliation: Kodagu Institute of Medical Sciences, Madikeri, India.
authors.forename: Bangalore Jayakrishnappa
authors.initials: BJ
authors.lastname: Mahendra
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.|Rabies Prevention Center, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sotheary
authors.initials: S
authors.lastname: In
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Hubert
authors.initials: H
authors.lastname: Barennes
authors.affiliation: WHO Collaborating Centre for Reference and Research on Rabies, Institut Pasteur, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Bourhy
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.|Rabies Prevention Center, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Yiksing
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Sowath
authors.initials: S
authors.lastname: Ly
authors.affiliation: Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.|GlaxoSmithKline, Vaccines Value & Health Sciences, Singapore.
authors.forename: Philippe
authors.initials: P
authors.lastname: Buchy
mesh_terms: D001007:Anxiety / Q000188:drug therapy / Q000209:etiology; D003906:Developing Countries; D018954:Drugs, Essential / Q000627:therapeutic use*; D006801:Humans; D010166:Palliative Care; D011818:Rabies / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D012424:Rural Population; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D013894:Thirst
chemical_list: D018954:Drugs, Essential
keywords: Rabia; cuidados paliativos; developing countries; diazepam; diazépam; hidrofobia; hydrophobia; hydrophobie; midazolam; palliative care; pays en voie de développement; países en vías de desarrollo; rabies; rage; soins palliatifs; traitement; tratamiento; treatment