Rabies is a topic covered in the 5-Minute Emergency Consult.

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CNS infectious disease of mammals caused by the rabies virus:
  • Highest case fatality rate of any known infectious disease


  • Epidemiology:
    • 30,000–70,000 people die/yr worldwide
    • Especially common in Southeast Asia, Philippines, Africa, South America, and Indian subcontinent
    • US has 2–3 human cases per year.
    • Most clinical cases in US from foreign travel and bat exposures
    • Raccoons, skunks, foxes, bats, dogs, woodchucks, groundhogs are reservoirs.
    • In US bats are the most common reservoir while abroad dogs are more common.
    • Squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, and rabbits can also be infected but there has never been a reported case of human transmission.
  • Pathophysiology:
    • Negative-stranded RNA genome, family Rhabdoviridae, genus Lyssavirus
    • Mode of transmission:
      • Contact with infected saliva of host
      • Bite: Most common
      • Nonbite: Saliva or bat aerosol exposure to an open wound or mucous membrane
      • Transplant procedures are the only well-documented person-to-person transmission
      • Not considered a transmission risk: Petting rabid animal or contact with the blood, urine, or feces of a rabid animal
    • Progression after infection:
      • Virus multiplies in local tissue and is taken up into muscle through n-acetylcholine receptors.
      • Virus enters peripheral nerves and is transported to CNS via retrograde axoplasmic flow at ∼1–4 inches per day
      • Once in CNS, rapid replication and dissemination cause encephalitis.
      • Centrifugal spread of virus to peripheral nerves, including salivary glands

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