Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges
- 1 June 2002
- journal article
- review article
- Published by Elsevier BV in The Lancet Neurology
- Vol. 1 (2), 101-109
- https://doi.org/10.1016/s1474-4422(02)00041-8
Abstract
Rabies is inevitably fatal and presents a horrifying clinical picture. Human rabies can manifest in either encephalitic (furious) or paralytic (dumb) forms. The brainstem is preferentially involved in both clinical forms, though there are no clinical signs of brainstem dysfunction. Differences in tropism at the inoculation site or the CNS, in the route of spread, or in the triggering of immune cascades in the brainstem may account for clinical variation. Rabies still poses diagnostic problems, particularly the paralytic form, which closely resembles Guillain-Barré syndrome, or when a patient is comatose and cardinal signs may be lacking. Molecular methods allow reliable detection of rabies-virus RNA in biological fluids or tissue before death. Deviations from the recommendations on prophylaxis of the World Health Organization lead to unnecessary loss of life. To date, attempts to treat human rabies have been unsuccessful.Keywords
This publication has 62 references indexed in Scilit:
- Rabies re-examinedThe Lancet Infectious Diseases, 2002
- Clinical Features of Nipah Virus Encephalitis among Pig Farmers in MalaysiaNew England Journal of Medicine, 2000
- Neurologic Complications in Children with Enterovirus 71 InfectionNew England Journal of Medicine, 1999
- Molecular Mechanisms in Synaptic Vesicle Endocytosis and RecyclingNeuron, 1996
- Ionizing radiation modulates the spread of an apathogenic rabies virus in mouse brainInternational Journal of Radiation Biology, 1996
- Evidence for a viral superantigen in humansNature, 1992
- Rabies in man handling infected calfThe Lancet, 1991
- Seizures as the initial manifestation of paralytic rabies.Journal of Neurology, Neurosurgery & Psychiatry, 1989
- Immunologic study of human encephalitic and paralytic rabies: Preliminary report of 16 patientsAmerican Journal Of Medicine, 1988
- Myelin Basic Protein as an Encephalitogen in Encephalomyelitis and Polyneuritis Following Rabies VaccinationNew England Journal of Medicine, 1987