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Transcript 
M. RASOOLINEJAD,MD
DEPATMENT OF INFECTIOUS DISEASE
TEHRAN UNIVERCITY OF MEDICAL SCIENCE
RABIES
Acute viral disease of CNS
All mammals
RNA virus Lassavirus Rhabdovirus
EPIDEMIOLOGY
Worldwide distribution( Australia,Antarcitica)
Urban rabies: dogs,cats
Sylvatic rabies: foxes, wolves, bats,…
Transmission: Bite
Aerosol
Ingestion
Transplantation
EPIDEMIOLOGY IN IRAN
Raccoon
fox
Bats
PATHOGENESIS
Live virus Epidermis, Mucus membrane
Peripheral nerve
centripettally
CNS ( gray matter )
centrifugally
Other tissue (salivary glands,…)
CLINICAL MANIFESTATIONS
1 – Non specific prodrome
2 – Acute neurologic encephalitis
Acute encephalitis
Profound dysfunction of brainstem
3 – Coma
4 - Death ( Rare cases  recovery )
CLINICAL MANIFESTATIONS
1 – Non specific prodrome
1 - 2 days  1 week
Fever, headache, sore throat
Anorexia, nausea, vomiting,
Agitation, depression
Paresthesia or fasciculations at or
Around the site of inoculation of virus.
CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis Phase
Furious Rabies
Dumb ( Rage tranquille )
(Landry/Guillain-Barre Syndrome)
CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis
1 – 2 days to < 1 week
Excessive motor activity, Excitation, Agitation
Confusion, Hallucinations, Delirium,
Bizarre aberrations of thought, Seizures,
Muscle spasms, Meningismus,
Opisthotonic posturing
Mental aberration ( Lucid period  coma )
Hypersalivation, Aphasia, Pharyngeal spasms
Incordination, Hyperactivity,
CLINICAL MANIFESTATIONS
2 – Acute Neurologic Encephalitis Phase
Fever T > 40.6
Dilated irregular pupils
 Lacrimation, Salivation & Perspiration
Upper motor neuron paralysis
 Deep tendon reflexes
Extensor plantar responses ( as a rule )
Hydrophobia or Aerophobia (50 -70% )
DIAGNOSIS
•Laboratory finding: ( CBC, CSF )
•Exclusion of other etiologies
•Pathology:
Formation of cytoplasmic inclusions:
( Negri bodies )
( Ammon’s horn, Cerebral cortex,
Brainstem, Hypothalamus,
The Purkinje cells of cerebellum,
Dorsal spinal ganglia )
DIAGNOSIS
•Isolation of virus (saliva,CSF, brain )
•Serology
•Viral Ag detection ( infected tissue )
•Viral DNA detection ( PCR )
DIFFERENTIAL DIAGNOSIS
Other viral encephalitis
Hysteria reaction to animal bite
Landry/Guillan-barre syndrome
Poliomyelitis
Allergic encephalomyelitis ( rabies vaccine )
PREVENTION
Preexposure Prophylaxis
Postexposure Prophylaxis
HUMAN RABIES BIOLOGICS PRODUCT
Rabies immune globulin:
HUMAN RABIES BIOLOGICS PRODUCT
Vaccine:
Human
Purified
Purified
Purified
diploid cell vaccine (HDCV)
chick embryo cell vaccine (PCEC)
Vero cell vaccine (PVRV)
duck embryo vaccine (PDEV)
PREEXPOSURE PROPHYLAXIS
Veterinarian, Cave explorers,
Lab workers, Animal handlers
Active immunization (Vaccine)
On days: 0, 7, 21 (28)
Booster doses (Neutralizing Ab <1:5 )
POSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatment
( Tetanus & Antibiotics )
2 – Passive immunization
3 – Active immunization
POSTEXPOSURE PROPHYLAXIS
1 – Wound cleaning & treatment
POSTEXPOSURE PROPHYLAXIS
2 – Passive immunization
HRIG 20IU/Kg IM on day 0
POSTEXPOSURE PROPHYLAXIS
3 – Active immunization
PREVENTION IN ANIMALS
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