Rabies
Etiologic agent
Epidemiology
Pathogenesis
Schematic representation of events in rabies pathogenesis following peripheral inoculation of rabies virus by an animal bite.
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Binds to nicotinic acetylcholine receptor at NMJ -> replicates locally within the muscle tissue -> travels retrograde.
Clinical manifestations
Incubation period is usually 1-3 months, but animals that are contagious (ie, have rabies virus in their saliva) will be symptomatic 5-10 days after becoming contagious.
| Prodrome | 1?~1? | Fever, headache, N/V, lethargy |
| Acute neurologic phase | 1?~1? | Confusion, delirium, hallucination |
| Coma, death |
Prodromal features
Ecephalitic rabies
- Hydrophobia
- Painful pharyngeal spasms ? avoidance of water
- Autonomic dysfunction
- Pupil dilation
- Hypersalivation; drooling
- Paresthesia
- Radiating proximally from a known wound site
Paralytic rabies
Laboratory investigations
Diagnosis
Rabies virus-specific antibodies
RT-PCR amplification
Direct fluorescent antibody testing
Differential diagnosis
Treatment
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Prognosis
Prevention
Postexposure prophylaxis
PEP is painful, costly, and intense (4 visits)
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- ????: HRIG(????) + Vaccination (inactivated vaccine)
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