Rabies encephalitis and extra-neural manifestations in a patient bitten by a domestic cat

Abstract

Rabies encephalitis is a fatal zoonotic viral disease transmitted to humans either by domestic animals like dogs and cats or by wild animals like bats, skunks and raccoons. We present the case of a 25-year-old woman admitted due to behavioral disorders, generalized paresthesiasand acute respiratory deterioration compatible with a respiratory distress syndrome (ARDS) requiring orotracheal intubation, mechanical ventilation and empirical initiation of antibiotic and antiviral therapy. Chest tomography showed pneumomediastinum and changes suggestive of pulmonary infection. In the presence of neurological symptoms, a central nervous system (CNS) infection was suspected and the cerebrospinal fluid showed no pleocytosis, hiperproteinorrachy without glucose consumption; cranial CT scan was normal. During hospitalization, the family reported that the patient was bitten by a cat 30-day prior to the onset of rabies-like symptoms, and the animal was sacrificed. The patient had an unfavorable clinical evolution, with electroencephalographic activity dissociation evidenced by video telemetry. The zoonotic exposure led to the suspected diagnosis of rabies infection. The patient died and the suspected diagnosis was confirmed by histopathology, with presence of Negri bodies on cerebellum Purkinje cells and a positive immunofluorescence test for rabies virus. Both, initial extra-neural manifestations and late reporting of rabies exposure led to delayed diagnosis.

Update on lyssaviruses and rabies: will past progress play as prologue in the near term towards future elimination?

“…For example, some of the highest case fatalities have occurred after human exposure to rabid wolves (likely infected originally by interactions with rabid dogs), given the risk for severe cranio-facial bites 92 . Also, while felids do not serve as typical reservoirs, they are highly efficient predators/vectors, presumably infected primarily during aggressive encounters with a bat, or via another mesocarnivore, such as a rabid dog, fox, raccoon, skunk, mongoose, ferret badger, etc., before a human or other species encounter 93 . In contrast to carnivores, vampire bats, as obligate vertebrate parasites, are the only mammals involved in natural viral exposures to other taxa directly because of their hematophagous nature, due to preying upon much larger livestock, humans, or other mammals 94 .…”

Host-microbe interactions at the blood-brain barrier through the lens of induced pluripotent stem cell-derived brain-like endothelial cells

“…Infectious meningoencephalitis/meningitis can be caused by a number of fungal, viral, or bacterial pathogens, with viruses and bacteria being the most common culprits ( 1 – 3 ). Known viral agents that cause meningoencephalitis include herpes simplex virus ( 4 , 5 ), human herpesviruses 6 and 7 ( 6 , 7 ), enteroviruses ( 8 ), Japanese encephalitis virus ( 9 , 10 ), West Nile virus ( 11 , 12 ), cytomegalovirus ( 13 , 14 ), varicella zoster virus ( 15 , 16 ), Epstein-Barr virus ( 17 , 18 ), human immunodeficiency virus ( 19 , 20 ), and rabies virus ( 21 – 23 ). Bacteria such as Escherichia coli K1 ( 24 ), Mycobacterium tuberculosis ( 25 ), Listeria monocytogenes ( 26 ), Streptococcus pneumoniae ( 27 ), Haemophilus influenzae type b ( 28 ), Group B Streptococcus (GBS) ( 29 , 30 ), and Neisseria meningitidis (Nm) ( 31 ) can cause bacterial meningitis in children and adults ( 3 ).…”

Comparing Intradermal (ID) Rabies Vaccination with Conventional IM Regimen on Humoral Response of New Zealand White Rabbits for the Production of Animal-Derived Polyclonal Antibodies

“…Clinical symptoms may include severe encephalitis and hydrophobia. It is transmitted through the saliva of a rabies mammal via skin or mucous membranes and hence causes severe infection [4].…”