A Reliable Diagnosis of Human Rabies Based on Analysis of Skin Biopsy Specimens

Dacheux, Laurent; Reynes, Jean-Marc; Buchy, Philippe; Ong, Sivuth; Diop, Bernard Marcel; Rousset, Dominique; Rathat, C; Jolly, Nathalie; Dufourcq, Jean-Baptiste; Chhor, Nareth; Diop, Sylvie Audrey; Iehlé, Catherine; Rajerison, Randrianasolo; Sadorge, Christine; Bourhy, Hervé

doi:10.1086/592969

Cited by 161 publications

(156 citation statements)

References 35 publications

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“…Intermittent shedding of the virus in saliva influences the diagnostic yield. The collection of 3 serial daily saliva samples enhanced the sensitivity to 100 % [116]. The difference in sensitivities between saliva swab samples (52.9 %; 17 samples) and liquid saliva samples (74.6 %; 67 samples) was not found to be statistically significant.…”

Section: Salivamentioning

confidence: 87%

“…A recent study demonstrated 100 % specificity in RT heminested PCR targeting the L polymerase gene in antemortem human rabies diagnosis [116]. The study demonstrated higher sensitivity of detection from skin biopsies (98.3 %) than from saliva (70.2 %), irrespective of the time of collection (from day 1 of illness to postmortem), but when 3 daily serial samples of saliva were tested, the sensitivity reached 100 %.…”

Section: Diagnosismentioning

confidence: 95%

“…The study demonstrated higher sensitivity of detection from skin biopsies (98.3 %) than from saliva (70.2 %), irrespective of the time of collection (from day 1 of illness to postmortem), but when 3 daily serial samples of saliva were tested, the sensitivity reached 100 %. Table 1 summarizes the information available from studies of diagnostic tests and their sensitivity and specificity in diagnosis [116][117][118][119][120] .…”

Section: Diagnosismentioning

confidence: 99%

“…The timing of biopsy influences the result, with 82 % sensitivity in first 4 days after onset of the disease, which drops to 60 % between 5 and 8 days after infection. RT-PCR assays have a much higher sensitivity, but PCR directed against the N gene has a lower sensitivity (70 %) [123] versus a very high sensitivity of > 98 % using RT hemi-nested PCR targeting the L polymerase gene [116].…”

Section: Skin Biopsymentioning

confidence: 99%

“…The timing of saliva sample collection greatly influences the yield of molecular diagnosis. Virus detection is highest during the first 2 to 3 days after the onset of symptoms and remains stable from day 2 to day 7, or even later [116,125]. Intermittent shedding of the virus in saliva influences the diagnostic yield.…”

Section: Salivamentioning

confidence: 99%

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Perspectives in Diagnosis and Treatment of Rabies Viral Encephalitis: Insights from Pathogenesis

et al. 2016

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Rabies viral encephalitis, though one of the oldest recognized infectious disease of humans, remains an incurable, fatal encephalomyelitis, despite advances in understanding of its pathobiology. Advances in science have led us on the trail of the virus in the host, but the sanctuaries in which the virus remains hidden for its survival are unknown. Insights into host-pathogen interactions have facilitated evolving immunologic therapeutic strategies, though we are far from a cure. Most of the present-day knowledge has evolved from in vitro studies using fixed (attenuated) laboratory strains that may not be applicable in the clinical setting. Much remains to be unraveled about this elusive virus. This review attempts to re-examine the current advances in understanding of the pathobiology of the rabies virus that modulate the diagnosis, treatment, and prevention of this fatal disease.

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Section: Salivamentioning

confidence: 87%

Section: Diagnosismentioning

confidence: 95%

Section: Diagnosismentioning

confidence: 99%

Section: Skin Biopsymentioning

confidence: 99%

Section: Salivamentioning

confidence: 99%

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Perspectives in Diagnosis and Treatment of Rabies Viral Encephalitis: Insights from Pathogenesis

et al. 2016

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Rabies: Virus and Disease

Nadin-Davis¹

2010

Encyclopedia of Life Sciences

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Rabies is an acute encephalomyelitis, caused by a group of genetically related lyssaviruses. The primary sources of rabies are major animal reservoirs in the orders Chiroptera and Carnivora, although this deadly zoonosis may affect all mammals, including humans. Despite the availability of biologicals that are efficacious in preventing the disease, once clinical signs develop, the disease is almost invariably fatal and kills over 50 000 people annually. The most effective control measures involve parenteral dog vaccination and oral vaccination of wildlife. Genetic analysis of lyssaviruses is extending our understanding of their diversity and evolution. The mechanisms that contribute to viral pathogenesis are being explored by studying the molecular interactions of the viral components with host cell factors. Such knowledge may provide for new less costly vaccines and effective therapeutic interventions in the future. Key Concepts: Rabies is a neurological disease that can affect almost all mammals and is almost invariably fatal once clinical signs develop. Rabies is caused by all members of the Lyssavirus genus, bullet‐shaped neurotropic viruses with small RNA genomes, which are normally transmitted in virus‐laden saliva through bites. Humans rarely transmit the disease to other humans but are exposed through contact with rabid animals. Prevention of human disease is undertaken by a regimen of timely post‐exposure prophylaxis. Distinct Lyssavirus species and variants thereof are maintained in dogs in the developing world and by several wildlife species including foxes, skunks, raccoons, raccoon dogs, mongooses, jackals and many species of bats. Through a series of viral–host interactions, rabies virus has evolved mechanisms that maintain the neural network required for its propagation and spread within the infected host while avoiding clearance by the host's immune system. Knowledge of the diversity of the Lyssavirus genus is steadily expanding with increased surveillance and development of molecular tools to enable rapid characterisation of new isolates. Current vaccines and biologicals are ineffective against the more diverse members of the genus thereby indicating that additional novel reagents may be required in the future. Ultimately, control and eradication of rabies will require elimination of the disease from animal reservoirs through the application of efficacious and cost‐effective methods of animal vaccination.

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Rabies: Virus and Disease

Nadin-Davis¹

2015

Encyclopedia of Life Sciences

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This article summarises the current literature on rabies and the aetiological agents responsible for this disease, which includes all members of the Lyssavirus genus, of which rabies virus ( RABV ) is the prototype species. Members of the orders Chiroptera and Carnivora serve as maintenance reservoirs for all recognised lyssavirus species and knowledge of the diversity, evolution and geographical range of these viruses is continually improving. Many mammalian species, including humans, are susceptible to spill‐over infections from the maintenance hosts. Despite the availability of efficacious prophylactics, once clinical signs develop, the disease is almost invariably fatal. Effective rabies control requires elimination of the disease from animal reservoirs. In developed countries, parenteral dog vaccination and oral vaccination of wildlife have effectively controlled rabies in many regions but socioeconomic factors limit the application of similar measures in many developing countries where the vast majority of human cases are reported. Better understanding of disease pathogenesis and host immune responses is sought in efforts to develop effective therapeutic interventions. Key Concepts Rabies is a neurological disease that can affect almost all mammals and is almost invariably fatal once clinical signs develop. Rabies is caused by all members of the Lyssavirus genus, bullet‐shaped neurotropic viruses with small RNA genomes, which are normally transmitted in virus‐laden saliva through bites. The vast majority of human rabies cases are the result of exposure to rabid animals. Prevention of human disease is undertaken by a regimen of timely post‐exposure prophylaxis. Distinct Lyssavirus species and variants thereof are maintained in dogs in many developing countries and by several wildlife species including foxes, skunks, raccoons, raccoon dogs, mongooses, jackals and many species of bats throughout much of the world. Through a series of viral–host interactions, rabies virus (RABV) has evolved mechanisms that maintain the neural network required for its propagation and spread within the infected host while avoiding clearance by the host's immune system. Knowledge of the diversity of the Lyssavirus genus is steadily expanding with increased surveillance and development of molecular tools to enable rapid characterisation of new isolates. Current vaccines and biologicals are ineffective against the more diverse members of the genus, thereby indicating that novel reagents with broader efficacy may be required for future disease control. Ultimately, control and eradication of rabies will require elimination of the disease from animal reservoirs through the application of efficacious and cost‐effective methods of animal vaccination.

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A Reliable Diagnosis of Human Rabies Based on Analysis of Skin Biopsy Specimens

Cited by 161 publications

References 35 publications

Perspectives in Diagnosis and Treatment of Rabies Viral Encephalitis: Insights from Pathogenesis

Perspectives in Diagnosis and Treatment of Rabies Viral Encephalitis: Insights from Pathogenesis

Rabies: Virus and Disease

Rabies: Virus and Disease

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