The effect of rabies immunoglobulin (RIG) applied to the anterolateral thigh on muscle functions and acute pain tracking

Abstract

Rabies is a zoonotic disease caused by Rhabdovirus, which causes severe damage to the central nervous system. Prophylaxis should be administered in case of bite, scratching or contact of saliva from a rabid animal with mucous membranes or open wounds. Since the incubation period in rabies is variable, it is categorized according to the type of contact and appropriate prophylaxis methods are applied according to WHO recommendations and the Ministry of Health Rabies Prophylaxis Guide. 4 or 5 doses of rabies vaccine, tetanus vaccine and RIG are administered in different protocols depending on the severity of the situation. The wound periphery, M. deltoideus and vastus lateralis part of M. quadriceps femoris are preferred as the application site for RIG. Rabies vaccine, tetanus vaccine, and rabies immunoglobulin (RIG) were administered to the case, who was admitted to the hospital as a stage 3 rabies suspect. The patient, aged 30 years and weighing 70 kg, was injected with 2800 IU (40 IU per kg) rabies immunoglobulin (RIG) from the anterolateral thigh to both vastus lateralis. As a result, muscle strength and VAS (Visual Analog Scale), a pain assessment scale, were measured by two different observers. Knee extension was 2+ on Day 1, 3+ on Day 5, and 5 on Day 9. Knee flexion was 2+ on Day 1, 4 on Day 5, and 5 on Day 9. In addition, the VAS in the case was evaluated as 7 immediately after the RIG application, and the VAS was expressed as 0 from the 9th day of follow-up. It is normal to experience some loss of knee extension after an irritating injection here. However, the vastus lateralis muscle has no role in hip flexion. It is not known exactly whether the hip flexion loss in our case is due to the indirect involvement of the femoral nerve or the continuous fascial (fascia profunda) connection of the muscles with each other. We think that clinical tests and measurements on this subject will be useful.