Rabies
2021年4月19日 (月) 11:13時点におけるVaccipedia.admin (トーク | 投稿記録)による版
目次
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
- prodromal symptoms 2-10 days
- itchy, tinglings, numbness around bitten site
- acute neurological period 2-10 days
- furious rabies - 80%
- hydrophobia, aerophobia, hypersalivation, hallucination, high grade fever
- paralytic rabies - 20%
- urinary retention →incontinence, constipation
- hydrophobia uncommon - difficult to diagnose
- coma to death of 100%
- furious rabies - 80%
