Rabies

PREM (2015A5PS862H)
BITS PILANI HYDERABAD CAMPUS
Introduction
Rabies is caused by a virus , which infects cell of
nervous system and is excreted later in the saliva

Zoonotic disease ( diseases that are transmitted to

humans by animals).

Any mammal can get rabies (including human)

Cats, cattle, and dogs
bats and foxes
Mode of transmission
• Most common modes
rabies virus is found in saliva, transmission to humans or
animals occurs as a result of a bite from a rabid animal

any contact of saliva with mucous membranes(eyes, nose,

mouth) or a wound

• Can also be transmitted by

drinking raw milk from rabies infected animals
organ transplant (human to human)
kidney transfer , cornea
Morphology of rabies virus
• Size is 180 nm * 75 nm, bullet shaped , ss RNA virus
• N proteins + RNA = nucleoprotein complex
Function of proteins
N protein: tight packaging of RNA, prevent from degradation

L protein: Viral RNA dependent RNA polymerase i.e make new

RNA for new formed virus

P protein: regulate L protein activity

M protein: packaging RNP in to new virus, virus envelope

G protein: bind with receptor of host cell

nicotinic acetylcholine receptor
low affinity NGF receptor
Pathogenesis:
Dysfunction of brain
1) Rabies virus alters the level of proteins involved in ion
haemostasis ( H+ ATPase and Na+/K+ ATPase
upregulated, Ca+2 ATPase downregulated )

2) Downregulation of proteins involved in docking and fusion

of synaptic vesicles to presynaptic membrane

3) Cell death by either apoptosis or necrosis

How rabies goes from bite site to brain ?

• p75NTR receptor, a protein found on the tips of

peripheral neurons( NGF)
• rabies virus behaves very similar to NGF
• It binds to p75NTR where it absorb in to neuron

• Transport independent of p75NTR is also more erratic,

with a larger proportion of viruses moving in the wrong
direction
• rabies virus is transported with p75NTR, it moves at
about 8 cm (a bit more than three inches) per day
Symptoms:
The period between the bite and the onset of symptoms is called
the incubation period.

 4 to 12 weeks
 can also range from a few days to six years.

 The initial onset of rabies begins with flu-like symptoms,

including:
fever
muscle weakness
tingling
feel burning at the bite site
Contd…
As rabies progresses, there are two different types of the
disease that can develop

 Furious Rabies
- exhibit signs of hyperactivity
excited behaviour
hydrophobia (fear of water)
insomnia
anxiety
confusion
agitation
hallucinations
excess salivation
Contd…
 Paralytic Rabies
Infected people slowly become paralyzed, will
eventually slip into a coma, and die.

take longer course than the furious form.

30 percent of rabies cases are paralytic.

Thanks
 Diagnosis
Tests that can be used to confirm a diagnosis of rabies in people who
are experiencing symptoms associated with rabies include:

skin biopsy - A sample of skin is taken (usually from the neck) and
examined under a microscope (skin biopsy) to determine whether the
virus is present. Samples of saliva are also examined to check for the
virus

saliva test – saliva can be tasted by virus isolation or traverse

transcription followed by polymerase chain reaction(RT PCR)
blood tests - your blood is checked for the rabies antibodies

Negri bodies- found in the cytoplasm of certain nerve

cells containing the virus of rabies
Treatment
Treatment after exposure can prevent the disease if
administered promptly, generally within 10 days of infection

Includes:
Management of animal bite wound(s)

administration of rabies immunoglobulin and immediate

vaccination
Management of animal bite wound(s)

 washing the wound as soon as possible with soap and

water for approximately five minutes is effective in
reducing the number of viral particles

 Povidone-iodine or alcohol is then recommended to

reduce the virus

 leave the wound open - do not try to stitch it because

this could expose your nerve endings to the rabies
virus
rabies immunoglobulin and vaccination

• Consist of 1 dose of immunoglobulin (20 IU/kg) and 5 doses of

rabies vaccine over 28 days (days 0,3,7,14 and 28)
• immunoglobulin works by stimulating the production of
antibodies that can stop the virus from spreading.

• If you have never been vaccinated, you should receive five

doses of the vaccine
• if you have previously been vaccinated, you should receive two
doses of the vaccine (start, second one three days later)
• The doses are given by injection into the shoulder muscle