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狂犬病临床表现及诊断

Author
Charles E Rupprecht, VMD, PhD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH
Translators
陈美芳, 副主任医师

引言

狂犬病是最古老、最可怕的人类感染之一，在所有感染性疾病中的病死率最高。

本文将总结狂犬病的流行病学、临床表现和诊断。狂犬病患者病情发作的处理以及感染预防将单独讨论(参见“狂犬病免疫球蛋白和狂犬病疫苗”和“应何时进行狂犬病预防”和“Treatment of rabies”)。狂犬病指南可在美国疾病预防控制中心(Centers for Disease Control and Prevention, CDC)的网站上获取：http://www.cdc.gov/rabies/。

病毒学

狂犬病是由狂犬病毒属弹状病毒科中多种嗜神经病毒所致[1,2]。以前认为所有狂犬病均由一种病毒导致。然而，抗原和分子遗传技术已经表明，该属中的多个病毒均可引起在临床上与狂犬病相似的疾病。对来自感染人类的病毒行基因测序也有助于确定可能的传播媒介，如银毛蝠或浣熊[3]。

弹状病毒体包含一个单链RNA基因组，其编码5种结构蛋白。其中一种基因编码外部糖蛋白，其为病毒中和抗体的主要靶点。针对内部核蛋白编码基因的核苷酸测序可鉴定出多种狂犬病病毒变异株，以及与之相关的宿主物种。

狂犬病病毒感染肌梭和支配该结构的神经。每个病毒体均包绕有脂蛋白包膜，包膜上分布有刺突糖蛋白[1]。在病毒侵染后，这些糖蛋白突出部分与一些特殊位点相结合，如肌细胞质膜上的烟碱型乙酰胆碱受体[4]。但神经元上不表达乙酰胆碱受体，因此可能存在其他尚未发现的受体。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-12.
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