Pathophysiologic studies in human rabies

Warrell, David A.; Davidson, Natalie; Pope, Helen M.; Bailie, W E; Lawrie, J. H.; Ormerod, L. David; Kertesz, Andrew; Lewis, Peter

doi:10.1016/0002-9343(76)90427-7

Cited by 78 publications

(32 citation statements)

References 28 publications

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“…Sinus tachycardia is very common and the heart rate is often greater than expected for the degree of fever. 74 A variety of cardiac arrhythmias may occur, including wandering atrial/nodal pacemaker, sinus bradycardia, and supraventricular or ventricular ectopic beats/arrhythmias, as well as heart failure, hypotension, and cardiac arrest. 72,74 The cardiac manifestations probably reflect infection involving the autonomic nervous system (eg, cardiac ganglia) or myocardium, 10 and there may be an associated myocarditis.…”

Section: Clinical Overviewmentioning

confidence: 99%

“…74 A variety of cardiac arrhythmias may occur, including wandering atrial/nodal pacemaker, sinus bradycardia, and supraventricular or ventricular ectopic beats/arrhythmias, as well as heart failure, hypotension, and cardiac arrest. 72,74 The cardiac manifestations probably reflect infection involving the autonomic nervous system (eg, cardiac ganglia) or myocardium, 10 and there may be an associated myocarditis. [11][12][13] Respiratory complications include hyperventilation, hypoxemia, respiratory depression with apnea, atelectasis, and aspiration pneumonia.…”

Section: Clinical Overviewmentioning

confidence: 99%

“…Magnetic resonance imaging may show normal studies, 77,78 and increased signals in gray matter areas have been observed. [74][75][76] Increased signals on …”

Section: Laboratory Diagnosis Of Rabiesmentioning

confidence: 99%

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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: Clinical Overviewmentioning

confidence: 99%

Section: Clinical Overviewmentioning

confidence: 99%

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Update on rabies

Jackson¹

2011

RRTM

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“…13 Selective infection of brainstem neurons near the nucleus ambiguous likely causes hydrophobia, and there is exaggeration of defensive reflexes protecting the respiratory tract. 24 …”

Section: Discussion (Part 3): Rabies Virus Epidemiology and Pathophysmentioning

confidence: 99%

The Recognition and Treatment of Rabies: A Case Report and Discussion

et al. 2015

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“…Rabies encephalomyelitis is one of the most agonizing and certain deaths imaginable 71 and fear of rabies affects the millions of people bitten by potentially rabid animals each year. Some idea of the burden of human suffering from rabies is provided by WHO's estimates of 60,000 deaths from dog-mediated rabies and the use of 50 million doses of vaccine for post-exposure prophylaxis in 1997 4 .…”

Section: Mad Dog Bite and Rabiesmentioning

confidence: 99%

‘To search and studdy out the secrett of tropical diseases by way of experiment’

Warrell

2001

Clinical Medicine

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-William Harvey wrote about malaria, snake bite and rabies, three diseases now having their greatest impact in tropical developing countries. Global malarial mortality has not declined for 50 years. The most effective control measure would be a vaccine. Temporary immunity in humans, through hundreds of bites by irradiated infected mosquitoes, was achieved in the 1970s. A promising current strategy is effector T-cell vaccination directed at infected hepatocytes. RTS,S/(SB)AS02, an adjuvanted fusion protein, produced transient protection in 70% of vaccines. Prime (DNA vaccine) boost (poxvirus recombinant) is particularly immunogenic. Pyrethroid-treated bed nets reduce childhood mortality and deplete the mosquito population, interrupting transmission. Chlorproguanildapsone is more effective than pyrimethaminesulfadoxine in treating uncomplicated chloroquine-resistant malaria. Artemisinin derivatives are as effective as quinine in severe disease. Snake bite is an underestimated and neglected cause of morbidity and mortality in rural communities in tropical countries. Sutherland's pressureimmobilisation technique is recommended firstaid for victims of neurotoxic elapid snakes. Rabies post-exposure prophylaxis, using new generation cell culture vaccines, is now feasible in developing countries, employing an economical 8-site intradermal regimen. This Harveian Oration, the first in 350 years to be devoted to tropical medicine, emphasises the importance of this speciality in the twenty-first century.Above all, William Harvey (1578-1657) believed in the experimental method and wanted to encourage the Fellows of this College to do research. He exhorted 'the ffellowes and members of the Colledge ... to search and Studdy out the secrett of Nature by way of Experiment' (Harvey Trust Deed 21 June 1656). My title reflects a personal enthusiasm for experiment in the field of tropical medicine. I cannot pretend that Harvey shared this interest, but he certainly mixed with people for whom diseases of warm climates were of real practical importance. His brothers traded with the Levant and the Far East and a colleague at St Bartholomew's Hospital, John Woodall (1556?-1643, was surgeon-general to the East India Company from 1613 to 1635 1 . As an example of the application of the experimental method to tropical medicine, I will discuss three diseases which I have found particularly interesting and challenging. I was delighted to find evidence in Harvey's writings that he had come across these conditions even though he never travelled outside Europe. MalariaHarvey experienced malaria both as patient and pathologist. Discussing the anatomical position of the liver and spleen in his Prelectiones anatomiae universalis, he mentioned that his spleen was enlarged during a quartan ague 2 and in De motu cordis et sanguinis, he described the effects of tertian fever on the heart and lungs, adding: 'I speak with experience on this point through my dissections of subjects who have died at the beginning of attacks' 3 .In those days, P...

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Pathophysiologic studies in human rabies

Cited by 78 publications

References 28 publications

Update on rabies

Update on rabies

The Recognition and Treatment of Rabies: A Case Report and Discussion

‘To search and studdy out the secrett of tropical diseases by way of experiment’

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