Chapter 41

Other Important
Viruses

Rabies Virus

Introduction of rabies
Rabies is an acute infection of the central
nervous system that is almost always fatal.
The virus is usually transmitted to humans
from the bite of a rabid animal.
Around the world, rabies kills 50,000 people
and millions of animals each year.

Biological characterization

Structure
Rod- or bullet-shaped particles, 75-180
nm
(-)ssRNA enveloped virus
genome codes for 5 proteins: G, M, N,
L, P

Structure of rabies virus

Rabies Virus

Structure of rabies virus

Rabies virus particles

Electron micrograph of rabies virus

Pathogenesis and symptomatology

Transmission
The essential first event in human or
animal rabies infection is the inoculation of
virus through the epidermis, usually as a
result of an animal bite.

Pathogenesis of rabies virus

Clinical findings
The disease is an acute, fulminant, fatal
encephalitis.
The incubation period in humans is
typically 1-2 months but may be as short as
1 week or as long as many years ( up to 19
years), depends on the distance between
bite site and CNS

Clinical Spectrum
Divided into three phases
A short prodromal phase
Lasts 2-10 days, nonspecific symptoms: Fever, headache,
malaise, anorexia, nausea and vomiting, sore throat.
An acute neurologic phase
Lasts 2-7 days, show signs of nervous system dysfunction:
sensitivity to light, sound and other sensory stimuli,
increased muscle tension, painful muscle spasms,
increased sweating, salivation or lachrymation,
hydrophobia ( fear of water) from fear of pain associated
with drinking
Coma
Death in 2-6 days from paralysis of respiratory muscles,
the mortality rate is 99%

Laboratory Diagnosis
Rabies disease may be diagnosed based on
animal biting history and typical clinical
symptoms.

Direct

immunofluorescent assay and

ELISA to detect the virus antigen, antibody
or Negri bodies.

Negri Bodies
Definition: An eosinophilic inclusion body
found in the cytoplasm of certain nerve cells
containing the rabies virus. Negri bodies are
important because their presence make
possible a positive diagnosis of rabies.

Negri Bodies

Epidemiology
Human exposures may be from wild animals or from
unimmunized dogs or cats.
Domestic animal bites are very important sources of
rabies in developing countries because of lack of
enforcement of animal immunization.
Worldwide, the occurrence of human rabies is
estimated to be 15,000 cases per year, with the highest
attack rates in Southeast Asia, the Philippines, and
the Indian subcontinent.

Prevention
Pre-exposure prophylaxis
Recommended for individuals at increased risk
of being exposed to rabies, such as
veterinarians, animal handlers, laboratory
workers, etc.
Consists of two subcutaneous injections of
inactivated vaccine given 1 month apart,
followed by a booster dose several months
later.

Treatment ( Post-exposure Prophylaxis)

immediate, thorough washing of wound with soap
and water ( for 10 minutes)
Passive immunization with hyperimmune globulin,
of which at least half the dose should be instilled
around the wound site
Active immunization with antirabies vaccine: five
doses given on days 1, 3, 7, 14 and 28 are
recommended.
Once rabies is established, there is nothing much
that could be done except intensive supportive care.

Key Points
Definition of Negri bodies
Transmission route of rabies
virus