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rabies virus
Epidemiology:
1) transmission can occur through the saliva of animals
2) animal hosts:
a) raccoons [3]
b) foxes
c) coyotes
d) bats
e) skunks
3) only 50% of patients with rabies have known exposure; thus diagnosis should be considered in any patient with encephalitis
4) case report of rabies from organ transplantation [6]
5) outbreak among ferret-badgers 2012, Taiwan
Pathology:
- retrograde axonal transport of the rabies virus to the CNS resulting in viral encephalitis
- putative receptor: acetylcholine receptor (muscarinic receptor) [2]
- from the CNS, the virus further spreads to other organs; the salivary glands receive high concentrations of the virus, thus allowing for transmission of rabies virus through saliva
- fatality can occur within anywhere from 2 days to 5 years from the time of initial infection
Genetics:
- enveloped with anti-sense single stranded RNA genome
- RNA is tightly bound by viral nucleoprotein
- RNA genome of the virus encodes 5 genes; these genes code for nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G) & viral RNA polymerase (L)
- all transcription & replication events take place in the cytoplasm inside a viral inclusion body, the Negri body
Laboratory:
- rabies virus serology
- rabies virus RNA
- rabies virus antigen in tissue
- rabies virus antigen in brain
- Rabies virus in brain by light microscopy
- rabies virus identified by culture
- see ARUP consult [5]
Complications:
- usually, but not always fatal [6]
Management:
- see rabies
Related
animal bite
human diploid cell rabies vaccine (Imovax, Imovax ID, HDCV)
rabies immune globulin (RIG, Hyperab Imogam)
rabies vaccine adsorbed (RVA, RabAvert)
rabies; hydrophobia
General
rhabdoviridae
Properties
KINGDOM: virus
GENOME-TYPE: RNA
SINGLE-STRANDED
NEGATIVE-STRAND
GENOME-SIZE: 13-16 kB
ENVELOPE: PRESENT
CAPSID-SYMMETRY: HELICAL
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 769
- Journal Watch 24(1):3, 2004
MMWR Morb Mortal Wkly Rep 52:1102, 2003
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a4.htm
- Rupprecht CE et al
Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure
Prophylaxis to Prevent Human Rabies: Recommendations of the
Advisory Committee on Immunization Practices
MMWR March 19, 2010 / 59(02);1-9
PMID: 20300058
http://cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm
corresponding NGC guideline withdrawn Jan 2016
- ARUP Consult: Rabies Virus
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/browse-all-topics
- Gilbert AT et al.
Evidence of rabies virus exposure among humans in the
Peruvian Amazon.
Am J Trop Med Hyg 2012 Aug; 87:206.
PMID: 22855749
- Willoughby RE Jr.
Resistance to rabies.
Am J Trop Med Hyg 2012 Aug; 87:205.
PMID: 22855748
- Centers for Disease Control and Prevention (CDC)
CDC confirms rabies death in organ transplant recipient
http://www.cdc.gov/media/releases/2013/s0315_rabies_organs.html
- Wu S et al
Centers for Disease Control and Prevention (CDC)
Notes from the Field: Wildlife Rabies on an Island Free from
Canine Rabies for 52 Years - Taiwan, 2013.
MMWR. February 28, 2014 / 63(08);178-178
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6308a4.htm
- Rabies, Centers for Disease Control (CDC)
http://www.cdc.gov/rabies/