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Clinical manifestations and diagnosis of rabies

Alfred DeMaria, Jr, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


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 [3].

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 [4].

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2016.
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