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Section 3. Summaries of Infectious Diseases
Rabies FN196
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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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, Lyssavirus genus.
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EPIDEMIOLOGY
Understanding the epidemiology of rabies has been aided by viral variant identification using monoclonal antibodies and nucleotide sequencing. In the United States, human cases have decreased steadily since the 1950s, reflecting widespread immunization of dogs and the availability of effective prophylaxis after exposure to a rabid animal. Between 2000 and 2007, 20 of 25 cases of human rabies reported in the United States were acquired indigenously. Among the 20 indigenously acquired cases, 17 were associated with bat rabies virus variants, and 1 had a history of a bat bite, had rabies antibodies in serum and cerebrospinal fluid (CSF) samples, but rabies virus antigens were not detected. Despite the large focus of rabies in raccoons in the eastern United States, only 1 human death has been attributed to the raccoon rabies virus variant. Two cases of human rabies were attributable to probable aerosol exposure in laboratories, and 2 unusual cases have been attributed to possible airborne exposures in caves inhabited by millions of bats, although alternative infection routes cannot be discounted. 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
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