Clinical manifestations and diagnosis of rabies
- Alfred DeMaria, Jr, MD
Alfred DeMaria, Jr, MD
- Medical Director, Bureau of Infectious Disease
- Massachusetts Department of Public Health and Laboratory Sciences
Rabies is one of the oldest and most feared human infections with the highest case fatality rate of any infectious disease.
The epidemiology, clinical manifestations, and diagnosis of rabies will be reviewed here. Management of patients with active rabies and prevention of infection are discussed separately (see "Rabies immune globulin and vaccine" and "When to use rabies prophylaxis" and "Treatment of rabies").
Although it was initially thought that a single virus was responsible for all rabies cases, rabies appears to be caused by a number of different species of neurotropic viruses in the Rhabdoviridae Family, genus Lyssavirus [1,2]. Antigenic and molecular genetic techniques have demonstrated that several viruses within this genus cause diseases clinically similar to rabies. Genetic sequencing of virus can help to determine the probable vector of transmission, such as a silver-haired bat or a raccoon .
The bullet-shaped, Lyssavirus virion contains a single-stranded RNA genome encoding five structural proteins. One of these genes encodes for an outer glycoprotein, which is a primary target for virus-neutralizing antibodies. Nucleotide sequence analysis of the gene that codes for the inner nucleoprotein enables the identification of the various rabies virus variants and their associated host species.
Viral tropism and dissemination — Lyssaviruses have a predilection for neural tissue and spread via peripheral nerves to the central nervous system (CNS). The mechanism by which rabies causes severe CNS disease is unclear. Lyssaviruses may produce neuronal dysfunction, such as autonomic instability, rather than neuronal death. Oxidative stress caused by dysfunction of mitochondria in neurons and other cells of the CNS may also be a pathway leading to the abnormalities observed .
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- Viral tropism and dissemination
- Host susceptibility to infection
- Geographic distribution
- - Animal reservoirs
- - Tissue or organ transplantation
- INCUBATION PERIOD
- CLINICAL MANIFESTATIONS
- Prodromal symptoms
- Clinical rabies
- - Encephalitic rabies
- - Paralytic rabies
- Laboratory findings
- Clinical diagnosis
- Laboratory diagnosis
- Sample collection
- Postmortem testing
- DIFFERENTIAL DIAGNOSIS
- TREATMENT AND PREVENTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS