Rabies

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epidemiology

  • endemic >150 countries
  • 55,000 deaths/year
    • mostly children in Asia and Africa
    • mainly in rural areas
  • most endemic in India followed by Bangladesh and China as well as Pakistan
  • Latin "rabere" = to rage, to rave
  • Sanskrit "rabhas" = to do violence

pathogen

  • family Rhabdoviridiae, genus Lyssavirus
    • Rabies lyssavirus
    • Duvenhage lyssavirus
    • European bat lyssavirus
  • negative polarity, monostrand RNA virus
  • enveloped
  • 5 component proteins
    • N, P, M, G, L
    • G (glycoprotein) is ligand to cellular invasion
      • target of vaccine
    • human receptor: nAChR, NCAM, p75NTR - all developed only in nerve cells


responsible animals

  • domestic animal - dog, cat in Asia and Africa
  • wildlife - bat, fox, raccoon, coyote in Europe and Americas
  • Lyssavirus circulates within a same animal species
    • sometimes transmitted to other species - "spillover" phenomenon
  • can infect all warm-blooded animals

pathophysiology

  • retrograde fast axonal transport CNS 15-100mm/day
  • spread from CNS to peripheral nerve
  • incubation 4-13 weeks, occasionally up to 6 years
  • despite catastrophic clinical outcome, histopathological changes in CNS are quite mild
    • macroscopically unremarkable
    • microscopically minimal changes characterized by perivascular cuffing of mild degeneration of neuron, microglial activation

transmission route to human

  • 99.99% animal bites
  • aerosol inhalation
    • in cave where infected bats live
  • organ transplantation
  • unrecognized exposure
    • ingestion of infected dog meat
    • butchering of infected dog

symptoms

  1. prodromal symptoms 2-10 days
    1. itchy, tinglings, numbness around bitten site
  2. acute neurological period 2-10 days
    1. furious rabies - 80%
      1. hydrophobia, aerophobia, hypersalivation, hallucination, high grade fever
    2. paralytic rabies - 20%
      1. urinary retention →incontinence, constipation
      2. hydrophobia uncommon - difficult to diagnose
    3. coma to death of 100%

diganosis

  • most of cases are diagnosed postmortem
  • history of animal bite
  • histology of autopsy-obtained brain specimen
    • microscopic observation of Negri body
  • immunofluorescnet
  • RT-PCR of N gene

prevention

  • PEP
  • PreP

control

  • exclusion of straydogs
  • establishment of dog registration
  • mass vaccination for dogs

JAPOHR Project

  • collaboration with STAREPS Project
  • one health approach