Rabies

Abstract

Rabies is an ancient disease, but it remains an important problem in countries with endemic dog rabies, especially in Asia and Africa. Rabies in wildlife, particularly from bats, is the main threat to humans in North America. Experimental studies in animals have given us detailed knowledge about the neural pathways of viral spread through the host. Human rabies often has distinctive clinical features reflecting the early brainstem involvement, including hydrophobia, but physicians in North America and Europe may not consider a diagnosis of rabies because the disease is rare and their lack of familiarity with the clinical manifestations. There is a progressive clinical course to coma and the disease is virtually always fatal. When rabies is treated aggressively there are often many medical complications, including multiple organ failure. Therapeutic attempts have been disappointing, but new approaches need to be taken in the future. An improved understanding of rabies pathogenesis might lead to important insights into the development of new therapeutic approaches.