Rabies Encephalitis Research Articles

Thailand: country survey of infectious diseases.

The author presents historical and socioeconomic comments followed by a discussion of common disease patterns; viral diseases (human imununodeficiency virus disease and infection dengue fever and dengue hemorragic fever viral hepatitis Japanese B encephalitis rabies); bacterial diseases (tuberculosis nontuberculous mycobacterium infection cholera enteric fever melioidosis traveler’s diarrhea leptospirosis sexually transmitted diseases anthrax rickettsial diseases plague); parasitic diseases (protozoa nematodes trematodes costodes); fungal diseases; and poisonous animals and fish.

Acute Respiratory Distress Syndrome Associated With Rabies: A Case Report

Acute respiratory distress syndrome (ARDS) is the first potentially lethal complication in rabies virus infection, although its occurrence is rare. We report on a fatal case of rabies virus infection in a 45-year-old woman from Hu-Nan Province, China. The neurologic signs of limb numbness and water phobia occurred from 61 days after the dog bite; the clinical course was progressive, with the most severe clinical manifestations being fever, encephalitis, and ARDS. The woman expired 12 days after admission to the hospital. An autopsy proved rabies encephalitis, mainly involving the medulla oblongata, the thalamus, part of the pons, the cerebellum, and the hippocampus. The lung pathologic examination revealed the organizing phase of ARDS with diffuse alveolar damage, hyaline membrane formation, type II alveolar cell hyperplasia accompanied by proliferation of fibroblasts and infiltration of mononuclear cells into the interstitial space. Immunohistochemistry stain and reverse transcription-polymerase chain reaction for rabies virus failed to demonstrate the organism in the lung tissue. Strong expression of inducible nitric oxide synthase (iNOS) was detected in the alveolar macrophages. An immunologic mechanism with iNOS expression in the absence of direct invasion of the organism may participate in the pathogenesis of ARDS associated with rabies.

Mumps meningitis in south-east Scotland—a retrospective study

Five methods for the RNA detection of rabies virus were directly compared in this study. These included conventional nucleic acid sequence-based amplification with electrochemiluminescence (NASBA-ECL) assay, reverse transcription (RT)-heminested (hn) polymerase chain reaction (PCR) and TaqMan real-time RT-PCR using protocols as described previously. The first two methods have been routinely utilised for ante-mortem diagnosis of human rabies in Thailand and other rabies-endemic Asian and African countries. In addition, two real-time NASBA assays based on the use of a NucliSens EasyQ analyser (NASBA-Beacon-EQ) and LightCycler real-time PCR machine (NASBA-Beacon-LC) were studied in parallel. All methods target the N gene, whereas the L gene is used for RT-hnPCR. Using serial dilutions of purified RNA from rabies-infected dog brain tissue to assess sensitivity, all five methods had comparable degrees of sensitivities of detection. However, both real-time NASBA assays had slightly lower sensitivities by 10-fold than the other three assays. This finding was also true (except for TaqMan real-time RT-PCR due to a mismatch between the target and probe sequences) when laboratory-adapted (challenge virus standard-11) virus was used in the assays. Testing on previously NASBA-ECL positive clinical samples from 10 rabies patients (saliva [6] and brain [4]) and 10 rabies-infected dog brain tissues, similar results were obtained among the five methods; real-time NASBA assays yielded false-negative results on 2 saliva samples. None of the assays showed positive results on cerebrospinal fluid specimens of 10 patients without rabies encephalitis. Due to the unavailability of the NASBA-ECL assay, the results show that TaqMan real-time RT-PCR and RT-hnPCR can be useful for ante- and post-mortem diagnosis of rabies.

Rabies encephalitis presenting as cerebral malaria

Rabies is carried mainly by mammalian carnivores and vampire bats in Latin America. However, rabies virus (RV) has been isolated in recent years from not only vampire bats in rural areas but also from several non-vampire bat species in urban areas, respectively. Therefore, rapid molecular screening is necessary for efficient epidemiology of these RVs. In this study, we investigated the usefulness of multiplex reverse transcription-polymerase chain reaction (RT-PCR) for determining the origins of 54 RV isolates from various host species in Brazil. And to evaluate the multiplex RT-PCR as a potential diagnostic tool, we investigated the sensitivity of this method. In addition, we compared the results with a phylogenetic tree developed from sequences of the RV glycoprotein (G protein) gene. Multiplex RT-PCR products showed five different sizes of products, whereas the phylogenic tree showed six groups. Of these six groups, four corresponded with the four sizes of the multiplex RT-PCR products. The other two groups showed correspondance with another one size of the multiplex RT-PCR products, indicating that multiplex RT-PCR results reflected the lineage of the 54 isolates. This study also showed that this method can detect trace amounts of RNA. In conclusion, this multiplex RT-PCR method allows the rapid, specific, and simultaneous detection of RVs isolated from various host species in Brazil.

Prophylaxis Against Rabies in Children Exposed to Bats

Rabies has become a disease of increasing concern. One reason is that bat variant rabies is a more common cause of human disease, with 1-2 deaths per year in the United States. Bat bites are much more difficult to document than bites from larger animals. Deaths from rabies encephalitis have remained undiagnosed until postmortem examination. Prophylaxis includes a series of 5 vaccinations during 28 days. Vaccine efficacy has been documented, even in young children.

Rabies in Four Organ Transplant Recipients

In May 2004, fatal rabies encephalitis occurred in four organ transplant recipients who had received tissues from the same donor, a previously healthy

Rabies: ancient yet contemporary cause of encephalitis

Christoph Schankin et al1 recently reported a patient who developed rabies encephalitis on his return from India. This report provides an opportunity to recall that rabies is not only an old fatal disease, whose first description dates from the 23rd century BC, but also a re-emerging zoonosis. Although preventable by vaccination, rabies is still not effectively controlled and its true impact is largely underestimated.2

Molecular detection of rabies encephalitis and correlation with cytokine expression

The purposes of this study were to elucidate the role of cytokine upregulation in the pathogenesis of rabies encephalitis and to compare the detection of Negri bodies with that of rabies protein by immunohistochemistry and rabies RNA by reverse transcriptase (RT) in situ PCR for its diagnosis. Negri bodies were evident in 4/7 of the documented rabies cases; viral protein and viral RNA were detected in each case. The average number of rabies-infected cells, determined by counting 150 neurons in serial sections in areas where viral protein was evident, with the three different detection methods was: Negri bodies (<1/150), immunohistochemistry (4/150), and RT in situ PCR (49/150). No rabies protein or RNA was detected in four control brain tissues that were read with the rabies cases in a blinded fashion. The ratio of cells expressing tumor necrosis factor α (TNFα) or inducible nitric oxide synthetase (iNOS) to 1 SSI-1/SOCS-1 (suppressors of cytokine signaling) expression, which is a novel class of negative feedback regulators of cytokine receptor signaling, was markedly increased only in the areas where many viral infected cells were present. Colabeling experiments showed that most of the cells expressing iNOS or TNFα were not virally infected, but rather adjacent to rabies-infected neurons. We conclude that RT in situ PCR for rabies virus is the most accurate test for the determination of viral load in rabies encephalitis. Further, the disease is characterized by massive viral infection of neurons in a markedly focal distribution in conjunction with a concomitant upregulation of cytokine expression in adjacent, noninfected cells that may be due, in part, to SOCS downregulation.

Intervention de la santé publique lors de la survenue d’un cas de rage humaine au Québec

In the fall of 2000, a nine-year-old child living in Montreal (Québec) died of rabies encephalitis. Cases of human rabies had not been reported in Canada for 15 years. The molecular characterization of viral nucleic acid implicated the Ln/Ps variant associated with the silver-haired bat and the eastern pipistrelle. This article describes and analyzes the intervention carried out by public health. The investigation revealed that contact with the bat must have occurred while the child was sleeping. Following the search for close contacts of the reference case, rabies postexposure prophylaxis (RPEP) was recommended to 59 people (3 household contacts, 12 playmates and 44 health care workers). Discussion with other public health departments in the province was important because of the media coverage of this case, which led to a considerable increase in the number of reported exposures to bats and in RPEP administration. Lessons learned from this event are that rapid and coordinated action with all stakeholders is essential to the success of this type of public health intervention and that the population must be informed of the risk of rabies transmission from bats.

Atlas of Travel Medicine and Health

SECTION 1 Water, Food, and Personal Hygiene: General Advice Accidents Animal Bites, Parasitic Infection, and Other Hazards: General Advice Biting Insects and Bugs: General Advice Sun and Heat: General Advice General Advice on Casual Sex and Blood-Borne Modes of Infection Medical Coverage/Insurance SECTION 2 Malaria Hepatitis A Hepatitis B Typhoid Yellow Fever Meningitis Schistosomiasis (Bilharzia infection) Dengue Polio Japanese B Encephalitis Tick-Borne Encephalitis Rabies Travelers' Diarrhea SECTION 3 Country-specific immunization advice, malaria advice and precautions, and other health topics (includes a map and weather chart for each country)

Sequence analysis of rabies virus in humans exhibiting encephalitic or paralytic rabies.

Two distinct clinical patterns, encephalitic (furious) and paralytic (dumb), have been recognized in human rabies. It has been postulated that different rabies virus variants associated with particular vectors may be responsible for these different clinical manifestations. Analysis of the glycoprotein (G), nucleoprotein (N), and phosphoprotein (P) genes of rabies viruses from 2 human cases of encephalitic rabies and from 2 human cases of paralytic rabies demonstrated only minor nucleotide differences. Deduced amino-acid patterns of the N protein were identical in both human and canine samples that came from the same geographic location, regardless of the clinical form. All differences in amino-acid patterns of the G protein were found outside the ectodomain, in either the signal peptide or the transmembrane and endodomains. None of the amino-acid differences of the P protein was within the interactive site with dynein. These findings support the concept that clinical manifestations of rabies are not explained solely by the associated rabies virus variant.

Rabies in a Thai child treated with the eight-site post-exposure regimen without rabies immune globulin

We report the case of a 7-year-old Thai girl that was bitten by a dog. She received prompt wound care followed by eight-site intradermal post-exposure rabies schedule using purified chick embryo vaccine. Treatment followed WHO recommendations for desperate situations where no rabies immune globulin (RIG) is available. The patient died 15 days later with classical symptoms and signs of encephalitic rabies.

Economical multi-site intradermal regimen with purified chick embryo cell vaccine (Rabipur) prevents rabies in people bitten by confirmed rabid animals

Objective: To determine the efficacy of a cost-effective multi-site intradermal regimen with purified chick embryo cell vaccine (PCECV Rabipur) in preventing rabies in people bitten by confirmed rabid dogs. Methods: Thirty-two people of different age groups who were severely bitten by confirmed rabid dogs were immunized with PCECV using the WHO recommended multi-site intradermal regimen of 0.1 mL of vaccine at eight sites on day 0, at four sites on day 7, and at one site each on days 28 and 90. In addition, passive immunization with human or equine rabies immunoglobulin was administered to 22 of these people before administering vaccine. They were followed for up to 3 years with periodic estimation of neutralizing antibody levels in their serum by mouse neutralization test (MNT). Results: There was an excellent immune response with more than protective titers (>0.5 IU/mL) on all days tested up to the end of the 3-year observation period. More significantly, protective titers were seen in all subjects by day 7. Only minimal side effects were observed. All the patients were doing well at the end of the 3-year observation period, which is generally considered to be the maximum incubation period for rabies in humans. Conclusions: It can be concluded that this multi-site regimen with or without passive immunization has prevented the development of rabies encephalitis in these people bitten by confirmed rabid dogs. This should encourage more such studies, so that this cost-effective economical regimen with safe and potent cell culture vaccines can replace highly reactogenic neural tissue-derived Semple vaccine in developing countries such as India.

Central nervous system infections in the rain forest zone of Nigeria

To ascertain incidence rates of central nervous system infections and provide information for health care planners. A two-stage screening through supervised case referrals and diagnostic evaluation at referral centre to establish a register of CNS infections. A rural community in the rainforest zone of Nigeria with land area of 186500 m2, average daily temperature of 28 degrees C, annual rainfall of 2080 mm, adult population of 109851 and served by 26 primary, three secondary and twelve comprehensive care facilities. More than two per cent of the populations live in waterlogged areas. Adults aged sixteen years and above, constituting incident cases of CNS infections. Incident CNS infections per 100,000 populations averaged over a two year observational period. Incidence rates were 3.6, 4.1, 2.3, 09, 1.8, 0.9 for acute bacterial meningitis, aseptic meningitis, rabies encephalitis, non-rabies encephalitis, tuberculous meningitis and chronic non-tuberculous meningoencephalitis, respectively. Syphilitic neuroarthropathy had 0.46. Mortality from acute pyogenic meningitis and tuberculous meningitis remained distressingly high. Aseptic meningitis had the highest incidence rate, yet remained inadequately emphasised. Rabies encephalitis was the third commonest cause of CNS infection in the area.

NEUROLOGICAL MANIFESTATIONS OF RABIES

BACKGROUND- Rabies is a fatal disease transmitted through bites of animals harboring the virus in their saliva. Rabies continues to be a scourge in developing countries. SUMMARY- The virus is initially transported from the site of inoculation to the central nervous system and is subsequently transported back to peripheral neural and extraneural sites via the axoplasm of the peripheral nerves. Encephalitic rabies is characterized by prominent limbic dysfunction. Paralytic rabies manifests as ascending paralysis resulting in quadriparesis. It can occur independently, or encephalitis may supervene terminally. Antemortem diagnosis is dependent on demonstration of the rabies antigen by fluorescent antibody technique in nuchal skin biopsies and corneal impression smears. The postmortem diagnosis of rabies is confirmed by demonstration of Negri bodies on histopathological examination of the brain. Treatment includes prophylactic administration of vaccine and rabies immunoglobulin. There is no known cure for the disease. CONCLUSIONS- Rabies often poses a diagnostic challenge to unsuspecting clinicians because of its varied and deceptive clinical manifestations. Early confirmation of the diagnosis is mandatory for obvious reasons. Education of the public and health workers is mandatory to decrease the ravages of this disease.

Role and control of 1L-6 in acute rabies encephalitis

Role and control of 1L-6 in acute rabies encephalitis

Human rabies infection: Diagnosis, therapy, and prevention

Human infection with rabies causes a severe viral encephalitis that is almost uniformly fatal. Human exposure to rabies occurs primarily via bite wounds from an infected animal with injection of infected saliva beneath the skin. Following any potential exposure, the physician must evaluate the likelihood that an actual rabies exposure occurred based on degree of contact and likelihood that the animal was infected. Once exposure is confirmed, postexposure prophylaxis with immunoglobulin and human rabies vaccine must be initiated immediately. If no prophylaxis is given and rabies encephalitis develops, the only available therapy is supportive care, with progression to multiorgan failure and death in essentially all cases.

Rabies

Rabies

Human Rabies—Montana and Washington, 1997

On January 5 and January 18, 1997, respectively, a man in Montana and a man in Washington died of neurologic illnesses initially suspected to be Creutzfeldt-Jakob disease (CJD) but diagnosed as rabies encephalitis during subsequent histologic examination on autopsy. The cases were not linked epidemiologically, and no secondary cases occurred. Postexposure prophylaxis (PEP) was administered to 113 potential contacts. This report summarizes the clinical presentations of the cases and the epidemiologic investigations by the Montana Department of Public Health and Human Services and the Washington State Department of Health; nucleic acid sequencing indicated that the silver-haired bat (Lasionycteris noctivagans) and the big brown bat (Eptesicus fuscus), respectively, were the probable sources of exposure.

Resurgence of rabies. A historical perspective on rabies in children.

Wildlife rabies in certain parts of the United States has been increasing. With greater urbanization, many areas have seen an influx of wild animals such as raccoons and foxes that are known wildlife reservoirs of rabies. Rabies encephalitis has been a fatal illness recognized by humans throughout history. The purpose of this review is to examine the history of rabies throughout the world to elucidate the evolution of popular and scientific knowledge of the disease in animals and humans. By examining this development from a pediatric perspective, we gain insight into the prevention and treatment protocols recommended for children today. Pediatricians need to include education about prevention and treatment of rabies exposures in their anticipatory guidance sessions with families.