11/153. Gelastic epilepsy possibly following antirabies vaccine. A case of child with gelastic epilepsy following administration of antirabies vaccine is presented. No associated structural brain could be identified in the patient. Possibility of relationship between antirables vaccine and gelastic epilepsy is discussed. ( info) |
12/153. Imaging findings in rabies encephalitis. SUMMARY: Rabies encephalitis is perhaps one of the few infectious diseases that command attention and fear not only from the layman but also from physicians. The unique mode of transmission, the virtually exclusive neurotransmission shown by the agent, and the complete hopelessness of the established disease sets rabies apart from other zoonoses transmitted to man. Rabies encephalitis is a fatal disease and its diagnosis is usually based on the clinical presentations and findings. Hence, imaging in rabies is seldom done, and imaging findings in rabies encephalitis have rarely been described. We present the imaging findings in two confirmed cases of rabies encephalitis in which antemortem diagnosis was obtained by corneal impression smears showing the presence of viral antigens. The differential diagnosis of the imaging findings as well as the role and the relevance of imaging in the diagnosis of this disease are discussed. The current literature on the subject is also reviewed. ( info) |
13/153. Failure of pre- and postexposure rabies vaccinations in a child infected with hiv. We report the case of a 6-y-old hiv-infected girl with severe immune deficiency who failed to respond to intramuscular pre-exposure rabies vaccination using human diploid cell rabies vaccine on days 0, 7 and 28. She also failed to respond to an intradermal postexposure rabies regimen using purified verocell rabies vaccine at 4 sites on days 0, 3 and 7 and at 2 sites on days 30 and 90 (double the usual regimen). Sequentially monitored rabies neutralizing antibody titers were below the WHO minimum acceptable level (> 0.15 IU/ml) in all specimens. Rabies prevention in hiv-infected persons with severe immune suppression requires further study. ( info) |
14/153. Rabies: otolaryngologic manifestations. Rabies is a rare, fatal viral infection, usually transmitted by the bite of an infected animal. Some 30,000 Americans are immunized annually, however, so public health considerations are common. The development of a new vaccine, grown in human diploid cell culture, is discussed. It appears to have high antigenicity with no serious morbidity. A case of a patient with fatal rabies who had fever, delirium, dysphagia, and cervical and pectoral subcutaneous emphysema is presented. ( info) |
15/153. Quantitative study of the infection in brain neurons in human rabies. rabies virus is a highly neuronotropic virus that causes encephalomyelitis. rabies virus infection was studied in neurons in the brain of an 8-year-old girl that died of rabies in mexico. The extent of the neuronal infection was evaluated quantitatively in neuronal cell types of the brain using histologic staining for Negri bodies and immunoperoxidase staining for rabies virus antigen in the same neurons. Quantitative image analysis was used to compare the amount of infection in five different neuronal cell types, which was expressed as a percentage of neuronal area. purkinje cells and periaqueductal gray neurons showed the largest percentage area for both Negri bodies and signal for rabies virus antigen. In general, there was a good linear relationship between the area of Negri bodies and the area of signal for rabies virus antigen. Many neurons with rabies virus antigen did not have Negri bodies, however, and some neurons with large antigen signals, especially purkinje cells and periaqueductal gray neurons, lacked Negri bodies. Formation of Negri bodies is likely influenced by factors that vary in different neuronal cell types. ( info) |
16/153. public health aspects of rabies. environmental health Services personnel are responsible for communicable disease surveillance and control, which includes rabies. They conduct contact investigation on all rabid animals reported by Veterinary Services. A patient admitted to USAF Hospital Clark with a clinical diagnosis of rabies (confirmed on autopsy) presented a more complex investigation problem. Identification of hospital personnel who had significant contact with the patient was relatively easy. There were 21 hospital personnel identified as requiring antirabies prophylaxis. Social contacts of the patient were more difficult to identify. Numerous friends and co-workers were interviewed. Only one person was determined to need prophylaxis as a result of the investigation. One of the most important aspects of any rabies investigation is coordination between all involved personnel. These personnel represent various disciplines including veterinary, medical, and public health (both military and civilian). If all individuals are to be identified, evaluated, and given complete, correct information, there must be open lines of communication between the various disciplines. ( info) |
17/153. Rabies in marmosets (callithrix jacchus), Ceara, brazil. A new rabies virus variant, with no close antigenic or genetic relationship to any known rabies variants found in bats or terrestrial mammals in the americas, was identified in association with human rabies cases reported from the state of Ceara, brazil, from 1991 to 1998. The marmoset, callithrix jacchus acchus, was determined to be the source of exposure. ( info) |
18/153. First case of human rabies in chile caused by an insectivorous bat virus variant. The first human rabies case in chile since 1972 occurred in March 1996 in a patient without history of known exposure. Antigenic and genetic characterization of the rabies isolate indicated that its reservoir was the insectivorous bat Tadarida brasiliensis. This is the first human rabies case caused by an insectivorous bat rabies virus variant reported in latin america. ( info) |
19/153. Rabies surveillance in the united states during 2000. During 2000, 49 states, the district of columbia, and puerto rico reported 7,364 cases of rabies in nonhuman animals and 5 cases in human beings to the Centers for disease Control and Prevention, an increase of 4.3% from 7,067 cases in nonhuman animals reported in 1999. Ninety-three percent (6,855 cases) were in wild animals, whereas 6.9% (509 cases) were in domestic species (compared wth 91.5% in wild animals and 8.5% in domestic species in 1999). Compared with cases reported in 1999, the number of cases reported in 2000 increased among bats, dogs, foxes, skunks, and sheep/goats and decreased among cats, cattle, horses/mules, raccoons, and swine. The relative contributions of the major groups of animals were as follows: raccoons (37.7%; 2,778 cases), skunks (30.2%; 2,223), bats (16.8%; 1,240), foxes (6.2%; 453), cats (3.4%; 249), dogs (1.6%; 114), and cattle (1.1%; 83). Ten of the 19 states where the raccoon-associated variant of the rabies virus has been enzootic reported increases in the numbers of cases of rabies during 2000. Among those states that have engaged in extensive wildlife rabies control programs, no cases of rabies associated with the epizootic of rabies in raccoons (or in any other terrestrial species) were reported in ohio, compared with 6 cases reported in 1999. No rabies cases associated with the dog/coyote variant (compared with 10 cases in 1999, including 5 in dogs) were reported in texas, and cases associated with the gray fox variant of the virus decreased (58 cases in 2000, including 38 among foxes). Reports of rabid skunks exceeded those of rabid raccoons in massachusetts and rhode island, states with enzootic raccoon rabies, for the fourth consecutive year. Nationally, the number of rabies cases in skunks increased by 7.1% from that reported in 1999. The greatest numerical increase in rabid skunks (550 cases in 2000, compared with 192 in 1999) was reported in texas. The number of cases of rabies reported in bats (1,240) during 2000 increased 25.4% over the number reported during 1999 (989) and represented the greatest contribution (16.8% of the total number of rabid animals) ever recorded for this group of mammals. Cases of rabies reported in cattle (83) and cats (249) decreased by 38.5% and 10.4%, respectively, whereas cases in dogs (114) increased by 2.7% over those reported in 1999. Reported cases of rabies among horses and mules declined 20% from 65 cases in 1999 to 52 cases in 2000. Four indigenously acquired cases of rabies reported in human beings were caused by variants of the rabies virus associated with bats. One case of human rabies acquired outside the united states that resulted from a dog bite was caused by the canine variant of the rabies virus. ( info) |
20/153. 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. ( info) |