Demonstration during Life of Rabies Antigen in Humans

Bryceson, A. D. M.; Greenwood, Brian; Warrell, David A.; Davidson, Natalie; Pope, Helen M.; Lawrie, J. H.; Barnes, H. John; Bailie, W E; Wilcox, G. E.

doi:10.1093/infdis/131.1.71

Cited by 66 publications

(9 citation statements)

References 7 publications

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“…There is infection involving cardiac ganglia and in the myocardium, 10 and, in some cases, there may be a myocarditis with clinical manifestations. [11][12][13][14] A skin biopsy is a useful antemortem diagnostic test in humans because the rabies virus antigen may be detected in nerves adjacent to hair follicles, 15,16 and/or the rabies virus RNA may be detected in the skin biopsy specimen using reverse transcriptionpolymerase chain reaction (RT-PCR) amplification. 17 The most detailed studies of events that take place during the incubation period in a natural model of rabies were performed by Charlton et al 18 in a skunk model.…”

Section: Overview Of Rabies Pathology and Pathogenesismentioning

confidence: 99%

Update on rabies

Jackson¹

2011

RRTM

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Human rabies is almost invariably fatal, and globally it remains an important public health problem. Our knowledge of rabies pathogenesis has been learned mainly from studies performed in experimental animal models, and a number of unresolved issues remain. In contrast with the neural pathway of spread, there is still no credible evidence that hematogenous spread of rabies virus to the central nervous system plays a significant role in rabies pathogenesis. Although neuronal dysfunction has been thought to explain the neurological disease in rabies, recent evidence indicates that structural changes involving neuronal processes may explain the severe clinical disease and fatal outcome. Endemic dog rabies results in an ongoing risk to humans in many resource-limited and resource-poor countries, whereas rabies in wildlife is important in North America and Europe. In human cases in North America, transmission from bats is most common, but there is usually no history of a bat bite and there may be no history of contact with bats. Physicians may not recognize typical features of rabies in North America and Europe. Laboratory diagnostic evaluation for rabies includes rabies serology plus skin biopsy, cerebrospinal fluid, and saliva specimens for rabies virus antigen and/or RNA detection. Methods of postexposure rabies prophylaxis, including wound cleansing and administration of rabies vaccine and human rabies immune globulin, are highly effective after recognized exposure. Although there have been rare survivors of human rabies, no effective therapy is presently available. Therapeutic coma (midazolam and phenobarbital), ketamine, and antiviral therapies (known as the "Milwaukee protocol") were given to a rabies survivor, but this therapy was likely not directly responsible for the favorable outcome. New therapeutic approaches for human rabies need to be developed. A better understanding of basic mechanisms involved in rabies pathogenesis may be helpful in the development of potential new therapies for the future.

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Section: Overview Of Rabies Pathology and Pathogenesismentioning

confidence: 99%

Update on rabies

Jackson¹

2011

RRTM

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“…Serum neutralizing antibodies against rabies virus are not usually present in unimmunized patients until the second week of the illness, and patients may die of rabies without developing a detectable serum antibody level (Anderson et al, 1984;Hattwick, 1974;Kasempimolporn, Hemachudha, Khawplod, & Manatsathit, 1991). Many sections of the biopsy specimen, which should include several hair follicles, are examined with fluorescent antibody staining for rabies virus antigen that is found in adjacent small sensory nerves (Bryceson et al, 1975;Warrell et al, 1988). One patient, who had received interferon therapy, had not developed antibodies by the time of death 24 days after the onset of symptoms (Sibley et al, 1981).…”

Section: Laboratory Studiesmentioning

confidence: 99%

Human Disease

Jackson

2013

Rabies

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“…Centrifugal viral spread to cutaneous nerve endings surrounding hair follicles (especially in the head region) forms the basis for antemortem diagnosis by means of immunostained nuchal skin biopsies, in a large proportion of animal (Blenden, Bell, Tsao, & Umoh, 1983) and human rabies cases (Blenden, Creech, & Torres-Anjel, 1986;Bryceson et al, 1975). In some cases, RVAg is also found in epidermal cells (Bago, Revilla-Fernandez, Allerberger, & Krause, 2005;Balachandran & Charlton, 1994;Jackson et al, 1999).…”

Section: Changes In Extraneural Organsmentioning

confidence: 99%