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There is usually a history of animal bite, though bat bites may not be recognized The prodromal syndrome consists of pain at the site of the bite in association with fever, malaise, headache, nausea, and vomiting The skin is sensitive to changes of temperature, especially air currents About 10 days later, the CNS stage begins, which may be either encephalitic ( furious ) or paralytic ( dumb ) The encephalitic form produces the classic rabies manifestations of delirium alternating with periods of calm, when attempts at drinking cause extremely painful laryngeal spasms (hydrophobia) In the less common paralytic form, an acute ascending paralysis resembling Guillain Barr syndrome predominates with relative sparing of higher cortical functions initially Both forms progress relentlessly to coma, autonomic nervous system dysfunction, and death despite intensive support

Question 5-1. What statements are generally used for conditional branching Question 5-2. True or false: an if statement s condition must evaluate to an expression. Question 5-3. Why should you use braces when there is only one statement following the if Question 5-4. What kind of expression can be placed in a switch statement Question 5-5. True or false: you can never fall through in a switch statement. Question 5-6. Name two uses of goto. Question 5-7. What is the difference between while and do...while Question 5-8. What are the three parts of a for loop header Question 5-9. What does the keyword continue do Question 5-10. What are two ways to create a loop that never ends until you hit a break statement

History of animal bite Paresthesia, hydrophobia, rage alternating with calm Convulsions, paralysis, thick tenacious saliva

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Rabies is a viral (rhabdovirus) encephalitis transmitted by infected saliva that gains entry into the body by an animal bite or an open wound Globally, an estimated 30,000 70,000 deaths occur annually from rabies, and as a cause of disability, it is roughly equivalent in its public health impact to trachoma or onchocerciasis In the United States, domestically acquired rabies cases are rare but probably underreported; eight human cases were reported in 2004 Raccoons, skunks, bats, and foxes are common wildlife reservoirs Unique geographic biting species that cause rabies in the United States include raccoons in the East, including New England; skunks in the Midwest, Southwest, and in California; coyotes in Texas; and foxes in the Southwest and in Alaska The contribution of bats (particularly the eastern pipistrelle bat and the silver-haired bat) to the rabid wild animal population is increasing, and bats are distributed throughout the United States As a result, most cases in the United States since 1990 until late 2005 (34 of 47 total) are associated with bat rabies virus variants Greater than 90% of human cases acquired in developing countries, where rabid dogs are the major reservoirs of the rabies virus, are due to infected dog bites Dogs and cats are rarely infected in the United States because of successful rabies vaccination campaigns Rodents and lagomorphs (eg, rabbits) are unlikely to spread rabies because they cannot survive the disease long enough to transmit it, although woodchucks and groundhogs can become infected and transmit the virus The virus gains entry into the salivary glands of dogs 5 7 days before their death from rabies, thus limiting their period of infectivity Less common routes of transmission include contamination of mucous membranes with saliva or brain tissue, aerosol transmission, and corneal transplantation Most recently, the rabies virus was transmitted to three persons who underwent solid organ transplant and one person who received a vascular segment from an infected donor with unrecognized rabies The incubation period may range from 10 days to many years but is usually 3 7 weeks The interval is dependent in part on distance of the wound from the CNS The virus travels in the nerves to the brain, multiplies there, and then migrates along the efferent nerves to the salivary glands Rabies is almost uniformly fatal, with only six documented surviving cases to date Five received either preexposure or postexposure prophylaxis Recently, a teenager survived with only naturally acquired immunity, but received intense antiviral treatment The most common clinical problem con-.

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