IS INJECTING A FINGER WITH RABIES IMMUNOGLOBULIN DANGEROUS?

KANITTA SUWANSRINON Queen Saovabha Memorial Institute, Thai Red Cross Society (WHO Collaborating Center for Research in Rabies), Bangkok, Thailand

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WIPAPORN JAIJAROENSUP Queen Saovabha Memorial Institute, Thai Red Cross Society (WHO Collaborating Center for Research in Rabies), Bangkok, Thailand

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HENRY WILDE Queen Saovabha Memorial Institute, Thai Red Cross Society (WHO Collaborating Center for Research in Rabies), Bangkok, Thailand

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VISITH SITPRIJA Queen Saovabha Memorial Institute, Thai Red Cross Society (WHO Collaborating Center for Research in Rabies), Bangkok, Thailand

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Treating potentially rabies virus infected wounds requires the injection of rabies immunoglobulin into and around the wounds, followed by vaccination with an approved tissue culture rabies vaccine. A significant number of such bite wounds involves fingers where there is little space for expansion. Injecting immunoglobulin into such areas under pressure may induce a compartment syndrome caused by compromising circulation. We carried out a retrospective review and a prospective study of patients seen with digital bite injuries and found that it is a safe procedure if carried out with care by experienced staff.

Author Notes

  • 1

    Expert World Health Organization Committee on Rabies, 1992. Eith Report. Geneva: World Health Organization.

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  • 2

    Hemachudha T, Laothamatas J, Rupprecht CE, 2002. Human rabies: A disease of complex neuropathogenic mechanisms and diagnostic challenges. Lancet Neurol 1 :101–119.

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  • 3

    Del Pinal F, Herrero F, Jado E, Fuente M, 2001. Acute thumb ischemia secondary to high-pressure injection injury. J Trauma 50 :571–574.

  • 4

    World Health Organization, 1996. Recommendations on Post-Exposure Treatment and the Correct Technique of Intradermal Immunization Against Rabies. Geneva: World Health Organization.

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  • 5

    Wilde H, Sirikawin S, Subcharoen A, Kingnate D. Tantawichien T,Harischandra PA, Chaiyabutr N, de Silva DG, Fernando L, Liyanage JB, Sitprija V, 1996. Failure of postexposure treatment of rabies in children. Clin Infect Dis 22 :228–232.

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  • 6

    Wilde H, Bhanganada K, Chutivongse S, Siakasem A, Boonchai W, Supich C, 1992. Is injection of contaminated animal bite wounds with rabies immune globulin a safe practice? Trans R Soc Trop Med Hyg 86 :86–88.

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