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Rabies 

Chapter:
Rabies
DOI:
10.1093/med/9780198729228.003.0105
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date: 17 November 2019

Rabies is a zoonosis caused by an RNA rhabdovirus that can affect the nervous system of all mammals, including humans, causing an acute encephalomyelitis and leading to painful death in almost all cases. According to World Health Organization estimates, 55 000 people die each year from rabies, mainly in Asia and Africa. The main indigenous animal reservoirs of rabies are usually dogs but may also be foxes, raccoons, and bats, depending on the location. The disease is transmitted from the saliva of an infected animal, usually through a bite. Rabies may manifest with an encephalitic form, presenting with agitation, delirium, and hydrophobia, or with a paralytic form which is commonly misdiagnosed. Diagnosis can be made with examination of hair follicles (immunofluorescence, polymerase chain reaction (PCR)), saliva (PCR), serum (antibodies), and cerebrospinal fluid (antibodies, PCR), and by examination of brain tissue (immunofluorescence, PCR). There is no specific antiviral therapy for rabies, and treatment is palliative. Pre-exposure prophylaxis of people involved in high-risk activities includes immunization with an inactivated vaccine. Post-exposure prophylaxis includes administration of rabies immunoglobulin (both locally in the wound and systemically) and active immunization with the vaccine.

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