Rabies viral encephalitis: clinical determinants in diagnosis with special reference to paralytic form

Gadre, Girish; Satishchandra, P; Mahadevan, Anita; Suja, M. S.; Madhusudana, Shampur Narayan; Challa, Sundaram; Shankar, S K

doi:10.1136/jnnp.2009.185504

Cited by 52 publications

(41 citation statements)

References 12 publications

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“…Verbal autopsy is unlikely to be able to identify such cases. Furthermore, an unknown proportion of human rabies victims in India develop more insidious paralytic or atypical features without hydrophobia or alternating excitation and lucidity, making it unlikely that rabies will be identified as the cause of death by their family, neighbors or medical staff [10]–[11],[34]–[35]. Paralytic rabies most often resembles other encephalomyelitides or Guillain-Barré syndrome/Landry's paralysis, but many other atypical presentations of rabies have been reported [12],[36]–[39].…”

Section: Discussionmentioning

confidence: 99%

Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey

et al. 2012

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BackgroundIt is estimated that India has more deaths from rabies than any other country. However, existing estimates are indirect and rely on non-representative studies.Methods and Principal FindingsWe examined rabies deaths in the ongoing Million Death Study (MDS), a representative survey of over 122,000 deaths in India that uses enhanced types of verbal autopsy. We estimated the age-specific mortality rates of symptomatically identifiable furious rabies and its geographic and demographic distributions. A total of 140 deaths in our sample were caused by rabies, suggesting that in 2005 there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. Most rabies deaths were in males (62%), in rural areas (91%), and in children below the age of 15 years (50%). The overall rabies mortality rate was 1.1 deaths per 100,000 population (99%CI 0.9 to 1.4). One third of the national rabies deaths were found in Uttar Pradesh (4,300) and nearly three quarters (8,900) were in 7 central and south-eastern states: Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam, and Madhya Pradesh.Conclusions and SignificanceRabies remains an avoidable cause of death in India. As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus. The concentrated geographic distribution of rabies in India suggests that a significant reduction in the number of deaths or potentially even elimination of rabies deaths is possible.

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Section: Discussionmentioning

confidence: 99%

Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey

et al. 2012

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“…Rabies virus may cause acute flaccid paraparesis 1–2 months after initial exposure 32. Early symptoms include behavioural changes and autonomic instability, followed by ascending paralysis associated with sphincter involvement and sensory disturbance.…”

Section: Neurological Conditions Which Mimic Gbs Mfs and Their Subtypesmentioning

confidence: 99%

Mimics and chameleons in Guillain–Barré and Miller Fisher syndromes

2014

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Guillain-Barré syndrome (GBS) and its variant, Miller Fisher syndrome (MFS) have several subtypes, together forming a continuous spectrum of discrete and overlapping syndromes. Such is the heterogeneity within this spectrum that many physicians may be surprised to learn that these disorders are related pathophysiologically, and therefore share certain clinical features. These include history of antecedent infection, monophasic disease course and symmetrical cranial or limb weakness. The presence of cerebrospinal fluid albuminocytological dissociation (raised protein, normal cell count), antiganglioside antibodies and neurophysiological evidence of axonal or demyelinating neuropathy also support a diagnosis in many cases, but should not be relied upon. Mimics of GBS and MFS can broadly be divided into those presenting with symmetrical limb weakness and those presenting with brainstem signs. MFS and the pharyngeal-cervical-brachial variant of GBS are frequently mistaken for brainstem stroke, botulism or myasthenia gravis, whereas Bickerstaff's brainstem encephalitis is often diagnosed as Wernicke's encephalopathy. Chameleons or atypical presentations of GBS-related disorders include: paraparetic GBS, bifacial weakness with paraesthesias, acute ataxic neuropathy, acute ophthalmoparesis, acute ptosis and acute mydriasis. Many neurologists may also not be aware that deep tendon reflexes remain present or may even appear brisk in up to 10% of patients with GBS. Correct diagnosis of GBS-related disorders helps to avoid unnecessary investigations and allows early immunotherapy if appropriate.

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“…In a study carried out at our center, fever at onset, paresthesias, muscular fasciculations, flaccid weakness confined to the bitten extremity, rapid deterioration with encephalon and autonomic involvement, cerebrospinal fluid (CSF) pleocytosis with demyelination, and axonal degeneration on electrophysiological studies were the cardinal features in cases of paralytic rabies, in contrast to conduction blocks in nerve conduction studies of GBS [84]. Variable lymphocytic infiltration, microglial nodules, and neuronophagia can be observed in the spinal cord in both GBS and paralytic rabies.…”

Section: Bat Rabiesmentioning

confidence: 99%

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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Rabies viral encephalitis: clinical determinants in diagnosis with special reference to paralytic form

Cited by 52 publications

References 12 publications

Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey

Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey

Mimics and chameleons in Guillain–Barré and Miller Fisher syndromes

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

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