Viral infection transmitted by mammals that causes CNS dysfunction
  • Highest case fatality rate of any known infectious disease


  • Epidemiology:
    • 35,000–59,000 people die per year worldwide
    • Especially common in Southeast Asia, Philippines, Africa, South America, and Indian subcontinent
    • The U.S. only has 2–3 human cases per year
    • Most clinical cases in the U.S. from foreign travel and bat exposure
    • In the U.S., bats are the most common reservoir (30.9%), followed by raccoons (29.4%), skunks (24.8%), foxes (5.9%), cats (4.4%), cattle (1.5%), and dogs (1.2%)
    • Worldwide, dog bites are most common vector
    • 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
    • Few rabies cases have been reported in transplant patients
  • Pathophysiology:
    • Negative-stranded RNA virus, family Rhabdoviridae, genus Lyssavirus
    • Progression of infection:
      • Virus multiplies in local tissue
      • Virus enters peripheral nerves and travels to the CNS
      • Once in the CNS, rapid replication and dissemination causes neuronal dysfunction
      • The virus then spreads back out along peripheral nerves to salivary glands, skin, cornea, and other organs

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