Hydrophobia Outside of Rabies?

Hydrophobia Outside of Rabies?

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Why does rabies cause hydrophobia?

Agony, Hydrophobia and viruses in the light of evolutionary principles

Has hydrophobia been found outside of rabies?

I have only seen it being mentioned as a symptom of rabies.

You are correct that hydrophobia is often considered pathognomonic of rabies. However, I offer for your consideration:

Hydrophobia as a rare presentation of Cotard's syndrome: a case report.1

Cotard's syndrome itself is a bizarre psychiatric condition that the authors of the above paper define well:

Cotard's syndrome is a rare condition where the central symptom is a nihilistic delusion, which, in its complete form, leads the patient to deny his own existence and that of the external world.

The patient described in this case report harbored delusions that his internal organs were shrinking. He asserted that his abdomen would rupture if he internalized anything. The hydrophobia was secondary to this concern. When given a glass of water he showed a panic reaction and attempted to keep away. Orientation and memory remained intact.

The authors go to length to point out that this was not, in fact, a case of rabies (as thought that were in question at this point!). Also, the patient himself was not aware of symptoms of rabies, ruling out "rabies hysteria" (a hypochondriacal delusion that one has rabies).

Hydrophobia, then, is a rare manifestation of a rare psychiatric disease in addition to the more frequent and well-known association with rabies.

1. Nejad AG. Acta Psychiatr Scand. 2002 Aug;106(2):156-8; discussion 158.

Hydrophobia is mostly attributed to rabies, most of the sources refer rabies as hydrophobia. Technically Hydrophobia is the intense fear of water.

Hydrophobia is an intense, irrational fear of water that can be commonly diagnosed at childhood and should be treated as soon as possible. Certain types of hydrophobia may also appear in later stages of contracting rabies, which would require treatment on an immediate basis.

Also the Wikipedia link for Rabies states that

Signs and symptoms may soon expand to slight or partial paralysis, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, and hallucinations, progressing to delirium. The person may have hydrophobia.

So rabies and hydrophobia are distinct and hydrophobia is a symptom of rabies.

Hydrophobia may, however, more readly be confronted with hysteria, acute mania and tetanus.

Hydrophobia is incidental to other diseases, it can be observed, occassionally, in tetanus,hysteria,cynanche,tonsillaris,tracheitis and certain inflammations in stomach. Tetanus is strongly believed to cause intense hydrophobia conditions.How ever, there is always a belief of hydrophobia linked with rabies.

The pathology of Hydrophobia and Tetanus is found to have great similarities and there is a great similarity in the distribution of lesion in the central nervous system as well as a certain analogy in the kind of lesion. The special localization of symptoms of both disease, in the tongue,throat and neck was associated with the special prevalence of the lesions in the medulla oblongata and especially in the neighborhood of the nuclei in the fourth ventricle etc.

Reference :THE Medical Times and Gazette - J & A Churchill

So it is possible to cause hydrophobic conditions when Tetanus is affected and also hydrophobia can occur from mental disorders.

Rabies molecular virology, diagnosis, prevention and treatment

Rabies is an avertable viral disease caused by the rabid animal to the warm blooded animals (zoonotic) especially human. Rabies occurs in more than 150 countries and territories. According to an estimation by WHO, almost 55,000 people die because of rabies every year. The Dogs are the major reason behind this, approximately 99% human deaths caused by dog's bites. Developing and under developing countries, both are the victims of rabies. With the post-exposure preventive regimes, 327,000 people can prevent this disease annually.

The current article mainly covers the genome, virology, symptoms, epidemiology, diagnostic methods, and the high risk countries around the globe.

Phobia lists

A large number of "-phobia" lists circulate on the Internet, with words collected from indiscriminate sources, often copying each other.

Some regard any attempt to create a list of phobias as an irrational endeavor because, theoretically, a person could become conditioned to have a fear of anything. Also, a significant number of unscrupulous psychiatric websites exist that at the first glance cover a huge number of phobias, but in fact use a standard text (see an example below) to fit any phobia and reuse it for all unusual phobias by merely changing the name. For a couple of striking examples.

". Poor performance or grades. Promotions that pass you by. moths phobia will likely cost you tens, even hundreds of thousands of dollars over the course of your lifetime, let alone the cost to your health and quality of life. Now Moths Phobia can be gone for less than the price of a round-trip airline ticket." ". The expert phobia team at CTRN's Phobia Clinic is board-certified to help with Russophobia and a variety of related problems. The success rate of our 24 hour program is close to 100%"

Rabies is an acute and fatal viral encephalitis caused by a single stranded RNA virus belonging to the genus Lyssavirus of the family Rhabdoviridae. It is one of the oldest disease known to mankind that continues to kill thousands of people every year in spite of the availability of effective vaccines and sera to prevent it. It is primarily a zoonotic disease transmitted to man by the bites from infected animals. It continues to be a major public health problem in India and other developing countries. As per the latest national survey conducted in 2003 about 20,000 people die of rabies every year in India and in more than 95 per cent cases the transmitting vectors are dogs1. Rabies is also emerging as an important disease in North America as several cases of human rabies have been reported due to exposure to bats2. Recently three cases of human rabies after organ transplantation occurred in America this cautions us that rabies should always be kept in mind in deaths due to non specific neurological illness and diagnosis ruled out by appropriate tests before organ transplantation3. Australia, which was hitherto considered rabies free, has also reported human rabies deaths due to bites from bats4. Rabies is present uniformly in all states of India except in Andaman, Nicobar and Lakshadweep islands.

The rabies virus is a bullet shaped virus measuring about 180 nm in length and 75 nm in width. It is an enveloped virus made up of lipoprotein over which numerous spikes are present. These spikes are made up of glycoprotein, which is necessary for attachment of the virus to receptors and hence determines the virulence of the virus. The other important proteins include the nucleoprotein (N) closely associated with the helical RNA, phospho-protein P, matrix protein M, and L protein. The rabies genome has about 12,000 nucleotides. The rabies and rabies related viruses are now classified into several genotypes. The strains prevailing in Asian countries belong to genotype I.

Pathogenesis, pathology and laboratory diagnosis

The infection occurs by inoculation of the virus in to the bite wound through the saliva of the infected animals. The receptors for rabies virus include nicotinic acetylcholine receptors, neural cell adhesion molecules (NCAM), and nerve growth factor receptors. There is an initial multiplication of the virus in the local musculature and spread via motor or sensory nerves to the spinal cord and brain. Once virus reaches the brain, there is extensive replication involving every region. Later, centrifugal spread of the virus occurs again through the nerves to nonneural organs such as salivary glands, skin, liver, heart, etc. Despite wide-spread replication, there are not many observable pathological changes in the brain except for the presence of Negri bodies. Recent evidence indicates that neuronal apoptosis could play a role in the pathogenesis of the disease5 other factors that could contribute to the disease process may be abnormalities in neruotransmitters, accumulation of nitric oxide and pro-inflammatory cytokines such as tumour necrosis factor-alpha (TNF-α)6. After a prolonged and variable incubation period ranging from few days to few years, rabies presents with two types of clinical manifestations: more common encephalitic form with classical clinical manifestations like hydrophobia, aerophobia and aggressive behaviour and less common paralytic rabies. Laboratory diagnosis may not be required in the first form but paralytic rabies needs laboratory confirmation. Several procedures are available for ante mortem diagnosis viz. immunofluorescence on corneal smear, skin biopsy, detection of viral antigen in saliva or CSF by ELISA, and recently developed molecular techniques like PCR. However, negative tests do not rule out rabies and confirmation is only by post mortem examination of brain smear by immunofluorescence.

Prevention of human rabies

Though rabies is a 100 per cent fatal disease, it is 100 per cent preventable if state of the art modern prophylactic treatment is instituted soon after the exposure. The WHO has given clear cut guidelines on the categorization of exposures, wound management, active immunization with vaccines and passive immunization with rabies immunoglobulins (RIG)7. All these three parameters are equally important. More than a decade ago, in most parts of the world, nerve tissue vaccines have been replaced by highly potent and safe cell culture vaccines like human diploid cell vaccine (HDCV), purified chick embryo cell vaccine (PCEC, Rabipur), and purified vero cell rabies vaccine (PVRV, Verorab). However, in India use of outdated and WHO banned Semple vaccine still continues. It is only recently that efforts have been made by Central Government to phase out this vaccine and replace with modern cell culture vaccines. For full protection, 5 doses of these vaccines are to be administered on days 0, 3, 7, 14 and 28. In all category III exposures, local infiltration of calculated doses of RIG is very essential. Many cases of rabies have occurred despite full course of vaccination but without passive immunization.

In order to economize the administration of cell culture vaccines and to make it more affordable, WHO has advocated abbreviated intradermal (ID) regimens, which saves almost 60 per cent of the cost. These regimens are now routinely followed in Thailand, Philippines and Sri Lanka. Two types of ID regimens are approved by WHO, viz., the 2 site regimen also known as Thai Red cross regimen (TRC, 2-2-2-0-1-1) in which 0.1 ml of vaccine is given ID over deltoids at 2 sites on days 0, 3, and 7 and at one site on days 28 and 90 the multiple site regimen (Oxford regimen) consists of giving 0.1 ml vaccine ID at 8 sites on day 0, at 4 sites on day 7, and at one site on days 28 and 90. Both regimens are effective in producing adequate neutralizing antibody titres. However, these ID regimens are yet to be approved by the Drugs Controller General (DCG) of India but likely to be approved and introduced shortly after the successful completion of the ongoing feasibility study being conducted by the Indian Council of Medical Research (ICMR).

Newer vaccines that have been developed for animal use include DNA vaccines, Vaccinia recombinant vaccines and modified live virus vaccines for oral vaccination of wild life. Incidence of wild rabies has been significantly reduced in Europe, America and Canada by effective oral vaccination programmes. However, bat rabies poses a significant threat to human population in these areas.

Pre-exposure vaccination is recommended to people at continued risk such as veterinarians, laboratory persons, dogcatchers, forest officials, etc. Only cell culture vaccines should be used. The recommended schedule is 1 dose of vaccine intramuscular (im) on days 0, 7 and 28. Pre-exposure vaccination of children in India (at least on voluntary basis) should be encouraged, as these constitute nearly 60 per cent of human rabies deaths. In spite of great advances in virology, there is as yet no treatment for rabies.

Treatment and recovery from rabies

None of the antiviral drugs tested have proven effective though some encouraging results were observed with anasthetic ketamine in experimental animals8. Therefore, every effort should be made to prevent this disease after a possible exposure.

Though rabies is considered 100 per cent fatal, well-documented survivals in animals have been reported. So far six cases of human survivors have been reported including one from India9 and a recent one from North America10. All these cases were of paralytic type and diagnosed by indirect evidence of high titres of rabies specific antibodies in CSF but neither virus nor viral antigen was demonstrated. Survival from disease should be considered as a rare possibility in paralytic forms of the disease particularly in pre vaccinated patients when clinical course is prolonged by life sustaining intensive care measures. But most often these heroic efforts have failed to save the lives of rabies patients. Therefore, rabies patients, particularly the encephalitic type, should be isolated, sedated and allowed to die as peacefully as possible.

It is unfortunate that in spite of availability of effective vaccines and sera, rabies takes such a heavy toll of lives in India. In neighbouring countries like Thailand, Sri Lanka and Philippines rabies deaths have been drastically reduced. The latest survey conducted by the Association for Prevention and Control of Rabies in India (APCRI)1 has revealed startling facts: about 20,000 human deaths annually out of which 89 per cent had not taken post exposure vaccination, children constituting almost 50 per cent, and 17 million animal bites annually out of which only half seek medical advice. This amply speaks of the level of public awareness about this dreaded disease.

There is an urgent need for combined efforts from both medical and veterinary services to evolve strategies not only to prevent human rabies deaths but also to plan future actions to bring down incidence of canine rabies, to reduce and eventually eliminate stray dog population. A National Rabies Control Programme should be able to address this issue.

1. Association for Prevention and Control of Rabies in India (APCRI). Assessing burden of rabies in India. A National Multicentic Survey, Progress Report, Bhubaneswar, India 2003.

2. Krebs JW, Mandel EJ, Swerdlow DL, Rupprecht CE. Rabies surveillance in the United States during 2003. J Am Vet Med Assoc 2004 225 : 1837-49.

3. Centers for Disease Control and Prevention (CDC). Investigation of rabies infection in organ donor and recipients-Alabama, Arkansas, Oklahoma and Texas, 2004. MMWR Morb Mortal Wkly Rep 2004 53 : 586-9.

4. McCormack JG, Allworth AM. Emerging viral infections in Australia. Med J Aust 2002 177 : 45-9.

5. Licata JM, Harty RN. Rhabdoviruses and apoptosis. Int Rev Immunol 2003 22 : 451-76.

6. Jackson AC. Pathogenesis. In: Jackson AC, Wunner WH, editors. Rabies. New York: Academic Press 2002 p. 245-82.

7. World Health Organization Expert Committee on rabies 8th report. Tech Rep Ser No. 824. Geneva: World Health Organization 1992 p. 53-7.

8. Lockhart BP, Tordo N, Tsiang H. Inhibition of rabies virus transcription in rat cortical neurons with the dissociative anasthetic ketamine. Antimicrob Agents Chemother 1992 36 : 1750-5.

9. Madhusudana SN, Nagaraj D, Uday M, Ratnawalli E, Kumar MV. Partial recovery form rabies in a six year old girl. Int J Infect Dis 2002 6 : 85-6.

10. Centers for Disease Control and Prevention (CDC). Recovery of a patient from clinical rabies - Wisconsin, 2004. MMWR Morb Mortal Wkly Rep 2004 53: 1171-3.

Department of Neurovirology

National Institute of Mental

Copyright Indian Council of Medical Research Jul 2005
Provided by ProQuest Information and Learning Company. All rights Reserved

  • The rabies virus infects the central nervous system, travelling from the peripheral nerves to the brain.
  • Symptoms include hydrophobia, paranoia, terror, mania, hallucinations, and delirium.
  • Once symptoms have presented, survival is rare, but treatment administered before the onset of symptoms is highly successful.
  • hydrophobia: An aversion to water, as a symptom of rabies.
  • zoonotic: of or relating to zoonosis, the transmission of an infectious disease between species.

Rabies is a viral disease that causes acute encephalitis (inflammation of the brain) in warm-blooded animals. Rabies literally means &ldquomadness&rdquo in Latin. The disease is zoonotic and can be transmitted from one species to another, commonly by a bite from an infected animal. In humans, rabies is almost invariably fatal if postexposure prophylaxis is not administered prior to the onset of severe symptoms.

Figure: Rabies Patient: Rabies symptoms include malaise, violent movements, terror, mania, and delirium.

The rabies virus infects the central nervous system, travelling from the peripheral nerves to the brain. In humans, the incubation period between infection and the first sign of symptoms is typically two to 12 weeks, although periods as short as four days and longer than six years have been documented. Incubation period depends on the quantity of virus introduced and the distance it must travel to reach the central nervous system. Once there, symptoms begin to show and the infection is virtually untreatable. Early-stage symptoms include malaise, headache and fever, violent movements, uncontrolled excitement, depression, confusion, agitation, anxiety, and hydrophobia. Late stage symptoms extend to paranoia, terror, mania, and hallucinations progressing into delirium. Once symptoms have presented, survival is rare. Death almost invariably occurs within two to 10 days. Treatment with human rabies immunoglobulin (HRIG) and rabies vaccine is highly successful if administered before the onset of symptoms.

Figure: Rabid Dog: Close-up of a dog&rsquos face during late-stage &ldquodumb&rdquo paralytic rabies. Animals with &ldquodumb&rdquo rabies appear depressed, lethargic, and uncoordinated. Gradually they become completely paralyzed. When their throat and jaw muscles are paralyzed, the animals will drool and have difficulty swallowing.

Rabies causes about 55,000 human deaths annually worldwide, with 95% of human deaths occurring in Asia and Africa. Roughly 97% of human rabies cases result from dog bites. In the U.S., animal control and vaccination programs have effectively eliminated domestic dogs as reservoirs of rabies. In several countries, including Australia and Japan, rabies carried by terrestrial animals has been eliminated entirely. While rabies was once eradicated in the United Kingdom, infected bats have recently been found in Scotland. In the U.S., the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments has dropped the number of recorded human deaths from 100 or more annually in the early 20 th century, to one to two per year (mostly caused by bat bites). Modern cell-based vaccines are similar to flu shots in terms of pain and side effects. The old nerve-tissue-based vaccinations that require multiple painful injections into the abdomen with a large needle are cheap, but are being phased out and replaced by affordable World Health Organization intradermal vaccination regimens.

Rabies may be diagnosed by PCR or viral culture of brain samples after death, or from skin samples taken before. Diagnosis can be made from saliva, urine, and cerebrospinal fluid samples with less accuracy. Cheaper rabies diagnosis will become possible for low-income settings using basic light microscopy techniques.

Louis Pasteur’s Research of Hydrophobia: The Discovery of Rabies

Today we know that Hydrophobia is, in fact, just the fear of water, and it is really a Psychological problem, more than a psychological one. But do keep in mind that science in the 1800s was just in its developing stages.

The virus strains which cause rabies had not even been discovered yet, and still, Louis Pasteur was able to provide a vaccine for the disease. This was a big feat for any scientist of the time and a big step in the world of science.

Rabies has been known to the world since 2000 BC. The first-ever recorded case of rabies is from the Mysopotaminian Codex of Eshnunna. The Greeks had their own beliefs about the cause of rabies being Lyssa, the spirit of mad rage.

Over time the disease caused much fear in the hearts of the world population. The number of stray animals, especially dogs, was much, and there was no effective cure or even a treatment for the cure, which is still today. With no proper treatment, people still die of rabies, and back then, there was no treatment, meaning death was imminent.

In the 1800s, the disease was rampant because the population of stray dogs was way too high. Those rabid stray dogs could infect any other animal, maybe the people’s cattle of their farm, and those infected animals could, in turn, infect their masters.

Due to their being no cure, most victims died because of the disease until the first-ever vaccine for the disease was ever invented.

Reason for Thinking Rabies to be Hydrophobia

Rabies was back then known as Hydrophobia. It was called that because people infected with the Virus showed a strong dislike in the intake of water, which made them believe that the infected developed a fear of water, which was not true. This was since Rabies causes the salivary glands to inflate. The virus multiples, which causes the person infected with the virus to have trouble swallowing water.

In a very ironic symptom of rabies, the inflation of the salivary glands not only caused trouble in swallowing water, but it also caused an intense thrust in the infected. So, when they say that rabies causes a painfully slow death, it is very true.

The Start of the Research Into Hydrophobia

The world was in for some relief from Hydrophobia when the well known French microbiologist Louis Pasteur took it upon himself to find a vaccine or a cure for Hydrophobia.

Louis Pasteur, along with Emile Roux for a long time, came up with an experiment.

Louis Pasteur had previously worked a great deal on attenuating bacteria, which cause chickens to have Cholera. He started by observing Rabies’ progress in different animals and noted all the symptoms of how they progressed and the conditions and health of those animals.

The Experiment

Later on, he and his team devised an experiment, and he infected rabbits with rabies in a series, and when those rabbits died of the virus, they would take spinal cord tissues of those rabbits.

A new generation of rabbits was affected by these spinal cord tissue samples. The new generation of rabbits also got infected with rabies, which let the experimenters know just how highly infectious this disease was.

Louis Pasteur injecting rabies virus into a rabbit’s brain, watched by two assistants.
21 November 1885 Published

Louis Pasteur then went on to think about what he dried these samples of infected tissue. This was done in hopes of killing or, at the very least, attenuating the virus- which was unknown at the time. They went to administer these dried spinal cord tissue to the infected rabbits with time and enough doses, the rabbit was cured of the disease.

The First Case to be Treated Successfully by the Pasteur Vaccine

Joseph Meister was brought to Louis Pasteur in 1885, a young man bitten by a rabid dog fourteen times. His mother brought him to Louis Pasteur- when she found out about his ongoing research on the disease- hoping that the man would be able to help her son.

By this time, the study on the rabbits had proved that giving the shots of dried spinal cord tissue was definitely doing something in the infected animals. After much deliberation among the team members, they all decided to treat young Joseph Meister.

On 6 July 1885, he was given the first shot of a rabbit’s dried spinal cord tissue infected by the virus, which had died 15 days earlier. 12 more shots followed this in the following 10 days. Louis Pasteur and his team kept a close watch on Joseph, and even after 100 days of the last shot of inoculation, young Joseph Meister was well and alive, showing no signs of rabies.

This was met with great applause from scientists worldwide, which led to the establishment of Louis Pasteur Institutes all over America so that people could get the inoculation closer to their home.

Some Other Successfully Treated Cases

Soon after, a case of rabid dogs biting some 4 children aboard a steamship going to Newark, New Jersey. The whole country campaigned to get the boys to Pasteur so that they could also get the cure. While that was not possible immediately, they were taken to a Dr.Osborne.Later, when they were taken to Dr.Pasteur, their effective treatment started.

They were inoculated with the vaccine created by Mister Pasteur. 22 shots were administered, and their health was monitored closely by the team, as was the case with Joseph Meister.

They were successfully inoculated and showed no symptoms of Hydrophobia. Not all the boys could be sent to the good doctor, though. The Scientific community was in awe of the man and his new findings.

After this, Algeria’s children also came to meet the doctor who could cure a rabid dog’s bite. Again the Dr.Pasteur’s treatment proved effective, and the patients were cured.

At his address to the French National Academy of Medicine, he presented his findings on his experiments on the rabbits and the case of Joseph Meister. He stated the need to establish rabbit farms, where the rabbits were regularly inoculated so that the vaccine could be made in abundance and was ready whenever the need arose.

Besides, he suggested the need to go around every town, city, village, and farm and inoculate the rabid animals to be treated. Their bite would not affect any other animal or human. In a sense, it was to stop the further growth of any rabid animals.

The good doctor always told patients that it was not a cure, but it was an inoculation stopping the disease’s spread. And it was noted that even if the patient was not rid of all the symptoms of ‘hydrophobia,’ they were further immune to another case if it ever happens again.

An improved version of the vaccine was released in 1908. The authorities all over the States, Europe, and other countries started a campaign with wildlife authorities to find rabies-infected animals and provide them with the vaccines. People get Inoculated before a bite today because they have the vaccine. Wildlife authorities regularly inoculate animals showing symptoms.

Vaccines and Treatment of Rabies Today

In 1932 nearly 50 years after the first treatment for Rabies was made available, the virus was identified. In 1932 Joseph Lennox Pawan was the first person to identify and name the Rabies Virus.

Today we use other human diploid cells (H.D.C.V), the rabies vaccine used, making Pitman-Moore L503 strain of the virus which has been attenuated. Other than that, a less- an expensive vaccine made with purified chicken embryo cell vaccines and purified Vero cell vaccines – used making the Wistar strain of the rabies virus (attenuated)- are used. The WHO recommends these.

According to WHO, millions of people are vaccinated for rabies every year as part of immunization. It is estimated that this vaccination saves around 250,000 lives every year. Vaccines now are available for immunization before you get infected or after you get infected as well.

Along with this today, most of the animals are also free of the disease. Any isolated event of such an animal reported is swiftly handled with the local authorities. A vaccine is provided to all those who came in contact with any rabid animal. All such animals are treated if they can be.

It has been 135 years since Louis Pasteur first came up with the very first Vaccine for Hydrophobia. Today, we know what virus causes the disease, it is known as Rabies, and inoculation saves lives worldwide. Sure, he was not right in calling it Hydrophobia, but then again, would that really matter what we call it as long as we find the proper treatment for it.

All the Information in this article has been taken from creditable sites. To know more about Rabies Vaccine, its history, uses, and types, click here.

To know more about the Initial Research of Hydrophobia and its treatment by Louis Pasteur, Check out the December 05, 1885 edition of Scientific American in the Archives of their official site.

To read more on the experiment conducted by Louis Pasteur and more of his successfully treated cases, please check out the December 19, 1885 edition of Scientific American.

All credit for the Aforementioned information has been taken from the above-mentioned sites and links.

Hydrophobia Outside of Rabies? - Biology

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About the Disease

The grim accounts told in the book to illustrate these points linking the disease to its mythical counterparts are not for the squeamish, but they do serve to show how those victims could easily be seen as that of the mythical monster, transforming upon a moment’s notice into a raging, uncontrolled beast, on account of the incubation period of the virus in the body. Losing all control over themselves, the onset of hydrophobia would drive these victims into a raging frenzy, biting haplessly into the air, uncontrollable spasms racking the body as the nerves’ synopsis fail to inhibit their receptors, causing the victim to die rather terribly without the aid of a vaccine to reduce their symptoms. An example of what rabies does to animals — namely dogs — may be found in this KOAT Action 7 News video, reporting on a case of rabies in a Valencia county animal shelter in New Mexico. As the report indicates, footage in this video may be sensitive to some viewers.

Regrettably, the 12 dogs in the kennel were euthanized as a result of the progressive state of the disease. There was little that could be done for them.

Like any compelling analytical survey does, the book delivers a full account for the historical development of its topic, in this case the vaccine as it was developed in the 19 th century by Louis Pasteur, a French chemist and self-taught microbiologist. The trials and tribulations as Pasteur set to discover what he did not know about rabies at the time is one of the more remarkable parts of this book. At one point, Wasik and Murphy account for why trained medical professionals from the 19 th century had such a profound lack of understanding for the disease, given that all the folklore and myth loosely based around the disease had undoubtedly compounded and misconstrued the truths behind the virus and its symptoms, so much so that 3 rd century Grecian philosophers and their observations of rabid dogs were more telling about how rabies really was over these learned medical practitioners, some 1,500 years later. It wasn’t until the discovery of the virus as a microbial organism that the dynamics for our understanding of rabies changed for the better.

Still, the modern world is not safe from this virus, as it kills many animals and even people from less stable regions around the globe each year. In more remote regions where government bodies lack an adequate infrastructure, rabies remains a deadly disease, to which even the Center for Disease Control and Prevention acknowledges its danger. The book discusses in its later chapters several threats that occurred across urban spaces in the United States during 2008 and even an outbreak of rabies amongst dogs on the island of Bali, where “the island’s first attempt to combat the outbreak was an unsuccessful culling campaign in which 100,000 dogs were killed” (Belford). With these incidents happening as recently as 2010, there is little doubt to the magnitude this disease can have on an isolated population, whether it be an inner-city or an island. One thing the book does well is that it ends with a hopeful look at what is being done in rabies research.

Case presentation

A 32-year-old Chinese man began to have frequent ejaculations on December 7 (day 1), 2014, at a frequency of 5–6 times a day these reached 20–30 times on day 3. When frequent ejaculation increased to 40–50 times on the morning of day 4, the patient went to a local clinic in Beijing that specialized in traditional Chinese medicine for treatment of “imbalance of Yin and Yang”. However, symptomatic treatment to rebalance Yin and Yang had no effect. In the same afternoon, he was sent to a community hospital in Beijing with the following symptoms: headache, dizziness, nausea, and malaise fever of 39 °C irritability tachyphrasia speech difficulty and hypersalivation. He was subsequently transferred to a tertiary hospital in Beijing for further diagnosis and treatment, but the etiology remained unidentified. At around 10:00 pm on day 4, the patient was sent to the Infectious Disease Department of Peking University Third Hospital, and then transferred to the Emergency Department due to tachycardia and dyspnea. His complaints included high penis sensitivity, painful erections, and ejaculations > 40 times a day triggered by any touch (or ejaculations without erection and release of semen) as well as headache, nausea, chest congestion, and fever. There was no significant improvement after fluid infusion, symptomatic treatment, and other supportive therapies. No diagnosis was made even after consulting urologists, neurologists, and psychiatrists until 5:00 pm on day 5 when rabies was finally considered as typical symptoms such as anemophobia, hydrophobia, and photophobia then emerged. After questioning the patient and his family, he admitted a history of a scratch on the right foot caused by a dog about 4 months earlier. The wound was superficial and left untreated, and neither rabies vaccine nor a passive immune preparation was given. At 10:30 am on day 6, he developed apnea and was intubated, and multiple vasopressors were given at the same time. His condition continued to deteriorate rapidly, and he was declared clinically dead at 12:59 pm the same day.

Two days after the death of the patient, positivity of rabies virus neutralizing antibody (the exact titer was not available due to the absence of quantitative analysis) in serum samples, and a positive lyssavirus signal in a polymerase chain reaction targeting the conserved region of the nucleoprotein gene of lyssaviruses in two saliva specimens were reported by Beijing Center for Disease Control and Prevention ( Thus, the diagnosis of rabies was officially established. The patient’s family refused the recommendation for autopsy.


Infection results most frequently from transmission of the virus from an infected animal to a human via a bite. Occasionally infection can also occur via an open wound, mucous membranes or even as the result of organ transplantation or laboratory accidents 1,2 .

In developed countries, most cases are the result of bites from rabid bats (or inhalation while visiting bat caves), whereas in the developing world, rabid dogs are the main source of human infection 1,2 .

Clinical presentation

Typically there is an incubation period of 2 weeks to 2 months 2 .

Before CNS manifestations, dorsal root ganglionitis can result in localized neuropathic pain in the region of exposure (bite) 3 .

Involvement of the CNS by rabies can take two forms, which do not appear to correlate with the site of the bite, previous immunisation, vector (bat, dog or other) or any other clinical feature 1-3 :

  1. classic rabies encephalitis (80%) equivalent to 'furious rabies' in dogs
  2. paralytic rabies (20%) equivalent to 'dumb rabies' in dogs
Classic rabies encephalitis

Encephalitis is by far the most common presentation of CNS involvement by rabies, accounting for 80% of cases. Symptoms are initially non-specific with general systemic symptoms, anorexia, irritability, inspiratory spasms and cough, autonomic dysfunction and altered mental status. With time classic symptoms and rabies encephalitis develop including hydrophobia, aerophobia and hypersalivation, agitation and even priapism 1,2 .

Paralytic rabies

Paralytic rabies is relatively uncommon accounting only for 20% of CNS infections in humans. It is characterized by bilateral global motor weakness resulting in bilateral facial weakness and quadriparesis, with relative sparing of the sensory system 1,3 . It clinically resembles Guillain-Barré syndrome 1,2 .


Once introduced into the soft tissues, the virus enters unmyelinated nerve fibers and travels retrogradely up the axons to the dorsal root ganglia, which can result in neuropathic pain 3 . Once it reaches the central nervous system dissemination is rapid accounting for the fulminant clinical course 2,3 .

Radiographic features

As is the case with other encephalitides, MRI is the only modality of any use in the diagnosis of CNS rabies, as CT is usually normal. Unfortunately, the very rapid progression of symptoms in this disease results in infrequent imaging, and a relative lack of literature on the imaging findings 1-3 .

Usually normal. Occasionally, non-specific hypoattenuation in the brainstem, mesial temporal lobes, basal ganglia and periventricular white matter may be evident 1,2 . If imaging is only obtained late in the course of the disease, hemorrhage and cerebral swelling may be evident 1 .

The main imaging feature is an increase in T2 signal (best seen on FLAIR) in the affected parts of the brain and spinal cord, with a predilection for grey matter structures. As the disease progresses, swelling becomes more marked and petechial hemorrhages occur, as well as contrast enhancement 1 . The distribution of imaging changes, naturally, depends on the type of involvement.

In classic rabies encephalitis, increased T2 signal has a predilection for the basal ganglia, thalami, hypothalami, brainstem, limbic system, and spinal cord as well as the frontal and parietal lobes 1-3 . In paralytic rabies, the involvement of the spinal cord and medulla are more pronounced, although no specific imaging features exist to allow differentiation from the classic encephalitic form 1,2 .


Reports of narrowing of terminal internal carotid arteries and distal basilar artery may be related to arterial spasm 2 .

Treatment and prognosis

Unfortunately, to date, no predictably effective therapy for CNS involvement by rabies has been developed, and in most cases, the disease results in a rapid decline of function, into coma and death 1,2 .

Typical therapeutic attempts, which if instituted early have in some instances resulted in survival include human rabies immunoglobulin infusion, rabies vaccine, ribavirin, interferon alfa, and ketamine 1 .

History and etymology

The word rabies has its origins in the Indian root word 'rabh', which means "to make violent" 2 .

Differential diagnosis

The differential diagnosis depends on the form of CNS involvement.

For classic rabies encephalitis, especially during the early phases, before the development of classic symptoms, imaging differential includes 1-3 :

  • other viral encephalitides e.g.
    • herpes simplex encephalitis: greater predilection for mesial temporal lobes and insular cortex, with sparing of the basal ganglia, thalami and brainstem

    For paralytic rabies, the main differential, and the cause of frequent delay in diagnosis, is Guillain-Barré syndrome 1 .

    Key Points about Rabies

    Worldwide, rabies still causes tens of thousands of deaths yearly, mostly in Latin America, Africa, and Asia, where canine rabies is endemic.

    In the US, rabies kills only a few people yearly it is usually transmitted by bats, but possibly by racoons, skunks, or foxes.

    Pain and/or paresthesias at the bite site are followed by encephalitis (causing restlessness and agitation) or by ascending paralysis.

    Biopsy neck skin for fluorescent antibody testing or do PCR of saliva, CSF, or tissue if patients have unexplained encephalitis or ascending paralysis.

    Treat patients supportively.

    Before exposure, give the rabies vaccine to people at risk (eg, veterinarians, animal handlers, spelunkers, workers who handle the virus, travelers to endemic areas).

    After exposure to an animal who has or is suspected of having rabies, thoroughly clean and debride any wounds, then give the rabies vaccine and rabies immune globulin .

    Raccoons, skunks, or foxes that have bitten a person should be regarded as rabid because bat bites can be minute and hard to detect, contact with a bat is an absolute indication for rabies immune globulin and the rabies vaccine.

    Watch the video: Poor Street Dog. Little Dog With hydrophobia rabies And screaming (May 2022).