Antemortem diagnosis and prevention of human rabies

Abstract

Human rabies still continues to be a significant health problem in India and other developing countries where dogs are the major vectors of transmission. Rabies in humans can present in two clinical forms, i.e., furious and paralytic. While diagnosis of furious rabies can be made based on the typical symptoms and signs, paralytic rabies poses a diagnostic dilemma to the neurologists who may encounter these cases in their practice. Although there are certain clinical features that distinguish this disease from other forms of Guillain-Barre syndromes, confirmation of diagnosis may require laboratory assistance. Conventional techniques such as antigen detection, antibody assays and virus isolation have limited success. The recently introduced molecular techniques show more promise in confirming the cases of paralytic rabies. There has not been much success in the treatment of confirmed rabies cases and recovery from rabies is extremely rare. Therefore, preventive measures of this dreaded disease after an exposure become extremely important. The present article reviews the current status of human rabies with regard to antemortem diagnosis, disease management and post-exposure prophylaxis.

Acute flaccid paralysis following spinal anaesthesia , A diagnostic dilemma

“…The local manifestations are the earliest symptoms which perhaps were neglected by the patient. Hallmark of paralytic rabies is an ascending paralysis 4 and this was evident in our patient. There are very few reports on the safety and anaesthesia and surgery in a patient receiving anti-rabies vaccination.…”

Detection of rabies virus nucleoprotein-RNA in several organs outside the Central Nervous System in naturally-infected vampire bats

“…Tests are performed on samples of saliva, serum, spinal ϐluid, and skin biopsies of hair follicles from the nape of the bat's neck. Saliva can be tested by virus isolation or RT-PCR (Madhusudana & Sukumaran 2008).…”

Rabies, a Vaccine Preventable Disease: Current Status, Epidemiology, Pathogenesis, Prevention and Control With Special Reference to India

“…RFFIT is widely used to estimate the seroconversion following preventive measures like prophylactic vaccination, and to help clinical detection of rabies in suspected cases. Diagnosis of RABV nucleic acid in the clinical samples like cerebrospinal fluid (CSF), saliva, skin biopsy and corneal impression smear by polymerase chain reaction (PCR) is documented as reliable for the ante-mortem diagnosis of rabies (Madhusudana & Sukumaran, 2008). Other tests which are established, which are in use in WHO or World Organization for Animal Health (OIE) reference laboratories to diagnose rabies includes tests based on the detection of nucleic acid like in situ hybridization, genome sequencing, etc .…”

“…Moreover, serum and spinal fluid can be tested for antibodies against rabies virus. Skin biopsy materials are examined for rabies antigen in the cutaneous nerve endings at the base of hair follicles (Madhusudana & Sukumaran, 2008;Dacheux et al, 2008).…”