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Rabies Virus Animation : Pathogenesis, Clinical manifestations, Diagnosis & Treatment | USMLE Step 1
Pathogenesis:
Rabies virus, a neurotropic virus belonging to the Rhabdoviridae family, primarily infects mammals, including humans, through the bite or scratch of an infected animal, commonly dogs or bats. Upon entry into the body, the virus replicates locally at the site of inoculation before spreading via retrograde axonal transport to the central nervous system (CNS). The virus then ascends along peripheral nerves, eventually reaching the brain, where it causes fatal encephalitis. The pathogenesis involves viral replication within neurons, leading to neuronal dysfunction, inflammation, and widespread neuronal death.
Clinical Manifestations:
The clinical manifestations of rabies typically progress through prodromal, acute neurologic, and paralytic phases. The prodromal phase is characterized by non-specific symptoms such as fever, malaise, headache, and discomfort at the site of the bite. The acute neurologic phase follows, marked by agitation, hallucinations, hydrophobia (fear of water), aerophobia (fear of air or drafts), hypersalivation, and paralysis. As the disease advances, patients may develop encephalitis, coma, and death due to respiratory failure within days of symptom onset if left untreated.
Diagnosis:
Diagnosing rabies involves a combination of clinical presentation, history of exposure to a rabid animal, and laboratory testing. Definitive diagnosis typically requires direct fluorescent antibody (DFA) testing or reverse transcription-polymerase chain reaction (RT-PCR) on samples obtained from skin biopsies of the nape of the neck or post-mortem brain tissue. Serological tests to detect rabies-specific antibodies may also aid in diagnosis, although they are primarily used for epidemiological purposes or to confirm past exposure to the virus.
Treatment:
Post-exposure prophylaxis (PEP) is the cornerstone of rabies treatment following exposure to a potentially rabid animal. PEP involves thorough wound cleansing with soap and water, followed by administration of rabies vaccine and rabies immune globulin (RIG) as soon as possible after exposure. The rabies vaccine stimulates the immune system to produce antibodies against the virus, while RIG provides immediate passive immunity. Once clinical symptoms develop, treatment is primarily supportive, focusing on symptom management and palliative care, as the disease is nearly always fatal once symptoms appear.
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