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Section 3. Summaries of Infectious Diseases
Rabies 1
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Infection with rabies virus characteristically produces an acute illness with rapidly progressive central nervous system manifestations, including anxiety, dysphagia, and seizures. Some patients may have paralysis. Illness almost invariably progresses to death. The differential diagnosis of acute encephalitic illnesses of unknown cause with atypical focal neurologic signs or with paralysis should include rabies.
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ETIOLOGY: Rabies virus is an RNA virus classified in the Rhabdoviridae family.
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EPIDEMIOLOGY: Understanding the epidemiology of rabies has been aided by strain identification using monoclonal antibodies and nucleotide sequencing. In the United States, the number of cases of human rabies has decreased steadily since the 1950s, reflecting widespread rabies immunization of dogs and the availability of effective immunoprophylaxis after exposure to a rabid animal. Between 1990 and 2001, a total of 26 (74%) of the 35 human rabies deaths in the United States have been associated with bat-variant rabies virus. Only 2 of these 26 human cases had known animal bites. Despite the large focus of rabies in raccoons in the eastern United States, no human deaths have been attributed to the raccoon rabies virus variant. Rarely, airborne transmission has been reported in the laboratory and in caves inhabited by bats. Transmission also has occurred by transplantation of corneas from patients dying of undiagnosed rabies. Person-to-person transmission by bite has not been documented in the United States, although the virus has been isolated from saliva of infected patients.
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Wildlife rabies exists throughout the United States except for Hawaii, which remains rabies free. Wild animals, including raccoons, skunks, foxes, coyotes, bats, and other species, are the most important potential source of infection for humans and domestic
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