「Rabies」の版間の差分
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| 49行目: | 49行目: | ||
==symptoms== | ==symptoms== | ||
#prodromal symptoms 2-10 days | #prodromal symptoms 2-10 days | ||
| − | ##itchy, | + | ##itchy, tinglings, numbness around bitten site |
#acute neurological period 2-10 days | #acute neurological period 2-10 days | ||
| − | ##furious rabies | + | ##furious rabies - 80% |
###hydrophobia, aerophobia, hypersalivation, hallucination, high grade fever | ###hydrophobia, aerophobia, hypersalivation, hallucination, high grade fever | ||
##paralytic rabies - 20% | ##paralytic rabies - 20% | ||
| − | ###urinary | + | ###urinary retention →incontinence, constipation |
| + | ###hydrophobia uncommon - difficult to diagnose | ||
##coma to death of 100% | ##coma to death of 100% | ||
| + | |||
| + | *[https://www.youtube.com/watch?v=GI5lW1wp6UU LANCET Rabies 1/3] | ||
| + | *[https://www.youtube.com/watch?v=GbTfdVRxhXs LANCET Rabies 2/3] | ||
| + | *[https://www.youtube.com/watch?v=9A8-CkrvZlQ LANCET Rabies 3/3] | ||
2021年4月19日 (月) 11:13時点における版
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%
