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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.
ETIOLOGY: Rabies virus is an RNA virus classified in the Rhabdoviridae
family.
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 2004, 34 (72%) of the 47 human rabies deaths
in the United States (46 in the United States and 1 in Puerto
Rico) have been associated with bat-variant rabies virus. Since
2000, 14 of 15 cases of indigenously acquired human rabies were
associated with bat variants, and only 3 of these 15 human cases
had known bat bites. Despite the large focus of rabies in raccoons
in the eastern United States, only one human death has been
attributed to the raccoon rabies virus variant. Rarely, airborne
transmission has been reported in the laboratory and in some
caves inhabited by millions of bats. Transmission also has occurred
by transplantation of organs, corneas, and other tissues 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.
Wildlife rabies exists throughout the United States except in Hawaii, which remains . . . [Go to Full Text]
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