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Viral Infections of Humans pp 665–690Cite as

Rabies

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Abstract

Rabies is an acute central nervous system (CNS) disease of mammals that almost invariably results in death. Disease develops following productive infection with a bullet-shaped, enveloped virus that contains single-stranded, nonsegmented, negative-sense RNA.(169) Rabies virus is the type species of the Lyssavirus genus, family Rhabdoviridae. In the usual scheme of pathogenesis, virus gains entry to the host body via the bite of a rabid animal. Historically in the United States, the primary source of human exposure was the domestic dog, which still predominates as the major reservoir in developing countries. Now, wildlife are primarily affected in developed countries: current rabies reservoirs in the United States include raccoons, skunks, foxes, coyotes, and bats.(88) The incubation period in humans is variable, from <10 days to > 6 years, but usually on the order of 4–6 weeks following an animal bite.(136) During the incubation period, virus is nearly undetectable and may replicate locally in muscle tissue at the initial site of entry.(34,35) Alternatively, virus may proceed directly and centripetally through the axoplasm of peripheral nerves to the CNS. Once in the nervous system, virus replicates and spreads quickly,(127) with associated dysfunctional clinical signs partially dependent on the affected area and relative severity of infection. Overt disease is initially nonspecific, consisting of signs and symptoms in humans compatible with a “flulike illness,” such as fever, headache, and general malaise. Following the prodromal stage, an acute neurological phase may include intermittent insomnia, anxiety, confusion, paresis, percussion myoedema, excitation, agitation, hallucinations, cranial nerve deficits, chorea, dysphagia, hypersalivation, piloerection, priapism, paralysis, and sometimes maniacal behavior.(75) Clinical presentation may also include classic symptoms of paresthesia at the site of bite exposure and hydrophobia (a synonymous term for the human disease)(57) or aerophobia manifesting as phobic pharyngeal spasms following provocative stimuli. The clinical course is acute, with death usually ensuing within days. A form of the disease termed “dumb rabies” may also present as part of the clinical spectrum, with the general sparing of consciousness together with ascending paralysis, progressive unresponsiveness, coma, and death. Once clinical signs are present, there is no cure. Intensive medical support may prolong life, but ultimately death ensues. Exceptions to this are exceedingly rare with only four well-documented cases of human survival from clinical rabies (all with a history of either pre- or postex-posure therapy).(1,23,73,109) Two of the four survivors have significant residual neurological impairment. Acquired immunity in the rabies vector species, presumably following subclinical exposure, abortive infection, or survival of overt clinical rabies, is apparently rare, but lias been supported to an extent by serological surveys of wildlife and documented occurrences under laboratory conditions.(50,54)

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  1. Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, 30333, USA

    Charles E. Rupprecht

  2. Zoonoses Program, New York State Department of Health, Albany, New York, 12237, USA

    Cathleen A. Hanlon

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  1. Department of Epidemiology and Public Health, Yale University School of Medicine, 06510, New Haven, Connecticut, USA

    Alfred S. Evans

  2. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 35294-0008, Birmingham, Alabama, USA

    Richard A. Kaslow

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Rupprecht, C.E., Hanlon, C.A. (1997). Rabies. In: Evans, A.S., Kaslow, R.A. (eds) Viral Infections of Humans. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-0036-4_22

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