1/13. Correlation of clinical and neuroimaging findings in a case of rabies encephalitis.BACKGROUND: Rabies encephalitis is a feared, virtually uniformly fatal form of central nervous system infection. The incidence of rabies encephalitis in the united states is almost certainly underestimated because of the predominance of bat-borne rabies, which can be spread without traumatic exposure. Because of its rarity in developed countries, rabies encephalitis has been seldom studied with modern imaging techniques. SETTING: University-based teaching hospital. PATIENT: A case of pathologically confirmed rabies encephalitis is presented. diagnosis of rabies was made by seroconversion testing while the patient was alive and was confirmed postmortem by the presence of rabies antigens and Negri bodies in the brain. The patient had 2 magnetic resonance studies done that showed dramatic abnormalities in the medulla and pons that correlated with features of the neurologic examination and hypothalamic-pituitary abnormalities. RESULT: The patient had a fulminant encephalitic course that ended in death. CONCLUSION: Rabies is an uncommon cause of fatal encephalitis. Anatomic imaging studies such as computed tomographic and magnetic resonance scans have generally been negative in confirmed cases of rabies. We report a case of confirmed rabies with extensive brainstem and hypothalamic-pituitary abnormalities on magnetic resonance imaging. Although these findings are nonspecific, they should raise the clinical suspicion of rabies in the setting of aggressive encephalitis of unclear cause, and appropriate diagnostic tests should be performed.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/13. A local outbreak of paralytic rabies in Surinam children.A rapidly fatal encephalomyelitis, which was in most cases characterized by ascending paralysis, developed in seven children of the age of 3 to 10 years in a bushnegro village in the interior of Surinam. rabies virus was recovered from the central nervous system of three autopsied children. Although the source of infection has not been detected, there is an indication that, at least in some cases, the disease has been transmitted by rat-bite rather than by vampire bats. During the same period a few cases of minor febrile illness occurred in the same community. Since virological and serological evidence of a wide-spread distribution of Coxsackie A virus type 4 was obtained, the latter illness may presumably be attributed to this virus.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/13. First human death associated with raccoon rabies--virginia, 2003.Rabies is an acute, progressive, incurable viral encephalitis, caused by the bite of an infected animal. In March 2003, a previously healthy man aged 25 years from northern virginia died from a diagnosed illness of meningoencephalitis of unknown etiology after a 3-week illness. Histopathologic review of central nervous system tissues at CDC revealed viral inclusions suggestive of Negri bodies, and subsequent tests confirmed a diagnosis of rabies. Genetic sequencing identified a rabies virus variant associated with raccoons, but how the patient became infected remains unknown. This report summarizes the investigation of the first documented case of human rabies associated with a raccoon rabies virus variant in the united states and highlights the importance of continued education in the prevention and diagnosis of rabies.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/13. Recovery of a patient from clinical rabies--wisconsin, 2004.Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and is nearly always fatal without proper postexposure prophylaxis (PEP). In October 2004, a previously healthy female aged 15 years in Fond du Lac County, wisconsin, received a diagnosis of rabies after being bitten by a bat approximately 1 month before symptom onset. This report summarizes the investigation conducted by the wisconsin Division of public health (WDPH), the public health response in Fond du Lac County, and the patient's clinical course through December 17. This is the first documented recovery from clinical rabies by a patient who had not received either pre- or postexposure prophylaxis for rabies.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/13. Rabies encephalomyelitis: clinical, neuroradiological, and pathological findings in 4 transplant recipients.BACKGROUND: Three patients received solid organ transplants from a common donor and were subsequently discharged from the hospital following an uneventful hospital course. Within 30 days, all 3 organ recipients returned to the hospital with varying symptoms that progressed to rapid neurological deterioration, coma, and death. OBJECTIVE: To describe the clinical, neuroradiological, and pathological findings of rabies virus infection in organ transplant recipients infected from a common donor. DESIGN: Case series involving a common donor and 3 organ recipients ascertained through review of clinical course and autopsy findings. A fourth case was determined by review of pending autopsy cases in which death occurred within the same time interval. Portions of postmortem central nervous system and organ tissues were frozen and formalin-fixed. Fluids and tissues were also collected for cultures, serology, and molecular studies. Postmortem fluids and tissues and antemortem fluids and tissues from all 4 transplant recipients and serum and banked lymphocyte or spleen cells from the donors were sent to the Centers for disease Control and Prevention for further evaluation. SETTING: Transplant unit of an urban teaching hospital. RESULTS: Antemortem cerebrospinal fluid analysis for 3 of the 4 recipients was consistent with a viral etiology. neuroimaging and electroencephalogram studies were suggestive of an infectious encephalitis or a toxic encephalopathy. Initial laboratory testing did not demonstrate an infectious etiology. Postmortem histologic analysis, immunohistochemistry, electron microscopy, and direct fluorescence antibody testing revealed rabies virus infection. Serological testing done postmortem confirmed rabies virus infection in the common donor. CONCLUSIONS: These cases demonstrate a risk for transmitting rabies virus infection through solid organ and tissue transplantation, and this diagnosis should be considered in any rapidly progressing neurological disease.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/13. Human rabies--florida, 2004.Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and nearly always fatal without postexposure prophylaxis. In February 2004, a man aged 41 years died after a 4-day hospitalization in Broward County, florida. A diagnosis of rabies was considered on the day before the patient's death; however, no antemortem samples were obtained for testing. In March 2004, postmortem samples of fixed brain material were sent to CDC, where laboratory testing confirmed a diagnosis of rabies, the 47th case of human rabies reported in the united states since 1990 (CDC, unpublished data, 2005). This report summarizes results of the subsequent investigation led by the Broward County Health Department and laboratory testing at CDC, which determined that the rabies virus was a canine variant present in haiti, where the man had traveled and reportedly been bitten by a dog. Rabies should be considered in persons after a dog bite, especially if the bite occurs in a country where canine rabies is enzootic.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/13. Transmission of rabies virus from an organ donor to four transplant recipients.BACKGROUND: In 2004, four recipients of kidneys, a liver, and an arterial segment from a common organ donor died of encephalitis of an unknown cause. methods: We reviewed the medical records of the organ donor and the recipients. blood, cerebrospinal fluid, and tissues from the recipients were tested with a variety of assays and pathological stains for numerous causes of encephalitis. Samples from the recipients were also inoculated into mice. RESULTS: The organ donor had been healthy before having a subarachnoid hemorrhage that led to his death. Encephalitis developed in all four recipients within 30 days after transplantation and was accompanied by rapid neurologic deterioration characterized by agitated delirium, seizures, respiratory failure, and coma. They died an average of 13 days after the onset of neurologic symptoms. mice inoculated with samples from the affected patients became ill seven to eight days later, and electron microscopy of central nervous system (CNS) tissue demonstrated rhabdovirus particles. Rabies-specific immunohistochemical and direct fluorescence antibody staining demonstrated rabies virus in multiple tissues from all recipients. Cytoplasmic inclusions consistent with Negri bodies were seen in CNS tissue from all recipients. antibodies against rabies virus were present in three of the four recipients and the donor. The donor had told others of being bitten by a bat. CONCLUSIONS: This report documenting the transmission of rabies virus from an organ donor to multiple recipients underscores the challenges of preventing and detecting transmission of unusual pathogens through transplantation.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/13. Rabies. A second Australian case, with a long incubation period.OBJECTIVE: The description of a second case of rabies in australia, stressing the clinical features and that long incubation periods are possible. CLINICAL FEATURES: A 10-year-old Vietnamese girl presented with fever, shoulder pain, subcutaneous emphysema, swallowing difficulty and agitation. After a period of maniacal behaviour all peripheral and central nervous system function was lost. INTERVENTION AND OUTCOME: Despite maximal intensive care, the patient died. The diagnosis of rabies was made at autopsy. CONCLUSIONS: Rabies occurs in australia and needs to be considered in the differential diagnosis of acute encephalitis and/or the guillain-barre syndrome. Incubation periods of more than six years can occur.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/13. A case of human rabies and ultrastructure of the Negri body.A 60-year old man, eight weeks after being bitten on his finger by a stray cat, developed symptoms and signs of rabies which progressed rapidly over the next two weeks and he died of respiratory failure. Pathological examination revealed characteristic cytoplasmic inclusions in neurons of various parts of the central nervous system and the dorsal spinal and sympathetic ganglia. The diagnosis of rabies was confirmed by direct fluorescent antibody staining of the brain tissue obtained at autopsy. On histological examination, most, if not all, of the neuronal cytoplasmic inclusions were eosinophilic and homogeneous and lacked the basophilic inner granules or bodies characteristic of Negri bodies. Nevertheless, they were ultrastructurally identical with Negri bodies by virtue of being made up of finely fibrillar matrix and virus and/or related particles in varying numbers. This indicates that ultrastructurally typica Negri bodies may or may not have the histologically visible basophilic inner bodies depending upon the degree of virus replication. In light of the ultrastructural evidence, lyssa bodies described in rabies in the past may represent Negri bodies without histologically recognizable inner bodies or cytoplasmic inclusions unrelated to rabies, occurring ordinarily in normal or degenerating neurons. It is, therefore, suggested that the term, lyssa body, is obsolete and should no longer be used.- - - - - - - - - - ranking = 0.26611641563038keywords = nervous system (Clic here for more details about this article) |
10/13. On the replication and spread of rabies virus in the human central nervous system.Ultrastructural and immunohistochemical studies on the brains of two autopsy cases of human rabies revealed: By the peroxidase-antiperoxidase method, viral antigens were present in all eosinophilic inclusions detected in formalin fixed paraffin sections. Numerous antigenic masses, which apparently corresponded to the matrices and cylindrical particles in neurites revealed by electron microscopy, were present in the neuropil remote from neuronal perikarya. There were virions in the intercellular spaces and virus-budding from the plasma membrane into the extracellular space in the absence of a matrix, strongly indicating that rabies virus in the human central nervous system could spread through the intercellular spaces and that the replication of the virus was not necessarily accompanied by the formation of inclusion bodies. The synapse was involved in rabies as indicated by virions in the synaptic terminals. The implications of these observations are discussed in conjunction with the results of previous in vitro and animal experiments.- - - - - - - - - - ranking = 5keywords = central nervous system, nervous system (Clic here for more details about this article) |
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