An Overview of Microbes Pathogenic for Humans
Nancy Khardori in Bench to Bedside, 2018
Rabies virus: Rabies virus infection if left untreated is almost always fatal; however, the disease can be prevented with administration of post-exposure prophylaxis and effective wound care. Initially, rabies may present as an influenza-like illness with nonspecific symptoms, which can persist for several days before the patient develops the classic symptoms associated with rabies, such as CNS dysfunction, hydrophobia, delirium, agitation, and insomnia. Transmission occurs via infected saliva or brain/nervous system tissue. Transmission of rabies usually occurs when an infected host bites an uninfected animal. Animal bites are almost always the method by which rabies is transmitted. While all mammals can become infected with the rabies virus, only certain ones are important reservoirs for the disease. In the United States, the main reservoir for rabies are bats; however, the virus has also been identified in raccoons, skunks, coyotes, and foxes. In the developing world, dogs continue to be the main reservoir for the virus. It is absolutely vital to seek medical attention immediately for post-exposure prophylaxis if any concern about being bitten by a rabid animal exists. Post-exposure prophylaxis consists of both passive (administration of the rabies immunoglobulin) and active immunization, i.e., administration of multiple doses of the rabies vaccine. Pre-exposure prophylaxis should be targeted for at-risk individuals, such as veterinarians and those traveling to endemic areas.
Animal Bites
Firza Alexander Gronthoud in Practical Clinical Microbiology and Infectious Diseases, 2020
Rabies is transmitted through saliva of an infected animal by a bite or scratch, or when saliva from an infected animal comes into contact with broken skin or mucous membranes (eyes, nose or mouth). Rabies virus then migrates to the central nervous system via the peripheral nerves, where it causes a fatal encephalitis. The virus replicates in the brain and disseminates to many different tissues. The incubation period of rabies is usually between 1 and 2 months; in rare cases, it can be as short as 4 days or up to 19 years. Most cases occur within a year. Bites in sites with many peripheral nerves such as the head, neck and hands have shorter incubation periods. The incubation period is also influenced by inoculum size. Infection with rabies manifests as furious rabies or, less commonly, paralytic rabies.
Rabies and other lyssaviruses
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Acute motor axonal neuropathy (AMAN), an axonal form of GBS, shares many clinical features with paralytic rabies [147,148] and Zika virus-associated GBS [149]. AMAN following Campylobacter jejuni infection may have preceding diarrhea that may be mistakenly diagnosed as a prodromal symptom of rabies. Areflexic quadriparesis and bilateral facial weakness without sensory deficits are observed in both conditions. Urinary incontinence is a common early symptom in paralytic rabies but rare in GBS. Inspiratory spasms with abnormal behavior may appear late in the clinical course and may be masked by generalized paralysis and superimposed metabolic disturbances that may occur in both conditions. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) (also known as GBS) or acute motor-sensory axonal neuropathy (AMSAN), and GBS-like syndrome following nervous tissue rabies vaccine may exhibit some degree of sensory deficit. These are usually absent in paralytic rabies. Furthermore, the presence of local prodromal symptoms even without a history of bite exposure and early autonomic dysfunctions (especially hypersalivation, abnormal pupils, and piloerection) suggests paralytic rabies.
Multi-Patient Rabies Exposure on a Colorado River Rafting Expedition: Urgent vs. Emergent Transport Decision Making in an Austere Setting
Published in Prehospital Emergency Care, 2018
Emily A. Pearce, Aaron N. Farney, Laura Banks, Andrew J. Harrell
Rabies is a fatal viral zoonosis and described by the CDC as a preventable viral disease usually transmitted by the bite of an infected animal during salivary shedding of the virus.2,3 The virus manifests itself by infecting the CNS, with a wide-ranging incubation period from several days to months.4 The absolute criticality of recognizing potential rabies exposure is self-evident: once symptoms of rabies present, including inappetance, dysphagia, cranial nerve deficits, abnormal behavior, ataxia, paralysis, altered vocalization, and seizures,2 the prognosis is considered almost 100% fatal, with only seven documented cases of survival, all except one of whom received some form of pre- or post-exposure prophylaxis prior to the onset of symptoms.5–7
Notifications of suspected rabies exposure increased in Finland: 26 years of one health surveillance, 1995–2020
Published in Infectious Diseases, 2023
Ruska Rimhanen-Finne, Jukka Ollgren, Tuija Gadd, Tiina Nokireki
Person-to-person transmission of rabies is very rare but has been documented in cases of organ and tissue transplantation [20]. In theory, transmission can occur when infectious saliva or tears get into an open wound or a mucous membrane. In 2007, exposure of hospital staff to a rabies patients’ saliva was explored in Finland [21]. Exposure of persons could not be excluded, and they were given vaccine prophylaxis. One hospital worker had suspected salivary-mucous membrane and blood exposure while cannulating the patient and was given immunoglobulin and vaccine prophylaxis. Post-exposure prophylaxis is recommended to health workers who examine a person with suspected or diagnosed rabies infection incurred via a needlestick or incision or if the saliva of a person with rabies comes into contact with the worker’s mucosa, broken skin or rash.
Child survivor of rabies in India: a case report
Published in Paediatrics and International Child Health, 2020
Biju John, Shyam Kumar, Sudeep Kumar, S. S. Dalal, Aneesh Mohimen
Rabies is an acute fatal encephalomyelitis caused by a Lyssavirus from the Rhabdoviridae family and is usually contracted following a bite by an infected mammal. Rabies transmitted by dogs is responsible for most human cases reported worldwide while bat-related rabies accounts for a significant proportion in the American continent. Approximately 59,000 people die of rabies annually, most of them in Asia and Africa. India alone contributes to almost a third of the global disease burden [1]. Rabies usually occurs in two classical forms: furious or encephalitic rabies which accounts for almost 80% of cases and paralytic or dumb rabies which accounts for the remainder. While clinical diagnosis of furious rabies following exposure can be straightforward, a diagnosis of paralytic rabies without a history of exposure can be challenging. In furious rabies, death ensues at an average 5.7 days from disease onset and death in the paralytic form at an average interval of 11 days [2]. Ante-mortem diagnosis of rabies which relies mainly on detection of rabies virus neutralising antibody can be a major challenge in those who have received post-exposure vaccination [3,4]. In the last several years, cases of rabies survivors have been reported in vaccinated individuals. There are, however, differences in the presentation and investigative findings [4]. A 4-year-old rabies survivor is presented and the evolution of his clinical, laboratory and radiological signs during hospitalisation is described.
Related Knowledge Centers
- Central Nervous System
- Dog Bite
- Encephalitis
- Lyssavirus
- Peripheral Nervous System
- Rabies Vaccine
- Rabies Virus
- Unconsciousness
- Viral Disease
- Australian Bat Lyssavirus