Rhabdoviruses (Table 1) infect plants, arthropods, fish, and mammals. The virion consists of single-stranded RNA with a helical nucleocapsid surrounded by a lipid bilayer envelope. Spikelike projections approximately 10 nm long extend from the surface of the lipid bilayer. Electron microscopy has shown that the virion has a bullet-shaped or conical appearance. The rabies virus is a neurotropic virus that infects all mammals; with very few exceptions, infection terminates in the death of the infected mammal. The rabies virus is transmitted through the saliva of infected animals, usually by a bite. After inoculation, the virus may invade the peripheral nerves or nerve endings directly. Following infection of the nerve cells, the viral genome progresses centripetally transneuronally, through retrograde axoplasmal flow to the central nervous system. In the CNS it proceeds from first-order neurons to second-order neurons. the neurons are the site of viral replication, mainly in the brain and spinal cord; from there the virus spreads to peripheral nerves and to some nonnervous tissue, including the salivary glands. After a variable incubation period, human disease usually begins with generalized symptoms of malaise, fever, fatigue, anorexia, and headache. Frequently (and characteristically for this disease), symptoms include pain and sometimes “tingling” at the site of exposure, which can be the first “rabies-specific” symptom. After this prodromal phase, behavioral changes may start to manifest, followed by rapidly progressing neurologic symptoms that lead to coma and death.

Table1. Rhabdoviruses

Only six cases of survival of a rabies infection have been documented worldwide. These cases include patients who survived without any complications; other patients have experienced significant neurologic impairment. In 2004, Randy Willoughby developed a treatment protocol for rabies referred to as “The Milwaukee Proto col.” This protocol requires that the patient remain in a prolonged state of generalized anesthesia, anti-viral drugs, and supportive, life-sustaining care until the individual’s natural active immunity is capable of clearing and/or fighting the infection. Updated protocol and statistics related to patient treatment and survival are maintained by the Medical College of Wisconsin and can be accessed at mcw.edu/Pediatrics/Infectious Diseases/ PatientCare/Rabies.htm

Animal rabies presents much as do human rabies cases. After the prodromal phase of the disease, a period of increased excitation occurs, with or without aggression. Clinical presentations of rabies often are described as “furious” or “dumb”; the furious type is associated with heightened aggression and agitation, and the dumb type with lethargy and paralysis.

Rabies is diagnosed by postmortem examination of brain tissue using a direct immunofluorescent assay. Specific sections of the brain are examined for the rabies antigen using fluorescent-tagged monoclonal antibodies and a fluorescent microscope. Prompt, accurate diagnosis of rabies infections in animals is important to ensure the success of postexposure prophylaxis for human victims of animal bites and injuries.

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مواضيع ذات صلة

Congenital Rubella Syndrome

Postnatal Rubella

Hendra Virus and Nipah Virus Infections

Measles (Rubeola) Virus Infections

Retroviruses

Reoviruses

Poxviruses

Role of Biomarkers in COVID-19

Mumps Virus Infections

Human Metapneumovirus Infections

Respiratory Syncytial Virus Infections

Parainfluenza Virus Infections