Virology, Immunology and Pathology of Human Rabies During Treatment

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Caicedo, Yolanda ; Paez, Andres ; Kuzmin, Ivan ; Niezgoda, Michael ; Orciari, Lillian A. ; Yager, Pamela A. ; Recuenco, Sergio ; Franka, Richard ; Velasco-Villa, Andres ; Willoughby, Rodney E.
• Description:
  Background
  
  Rabies is an acute fatal encephalitis caused by all members of the Lyssavirus genus. The first human rabies survivor without benefit of prior vaccination was reported from Milwaukee in 2005. We report a second unvaccinated patient who showed early recovery from rabies and then died accidentally during convalescence, providing an unparalleled opportunity to examine the histopathology as well as immune and virological correlates of early recovery from human rabies.
  
  Methods
  
  Case report, rapid fluorescent focus inhibition test, enzyme-linked immunosorbent assay, indirect and direct fluorescent antibody assays, reverse-transcriptase polymerase chain reaction, phylogenetic reconstruction, isolation in tissue culture, pathology and immunohistochemistry.
  
  Results
  
  The 9 year old died 76 days after presenting with rabies of vampire bat phylogeny transmitted by cat bite. Antibody response in serum and cerebrospinal fluid was robust and associated with severe cerebral edema. No rabies virus was cultured at autopsy. Rabies virus antigen was atypical in size and distribution. Rabies virus genome was present in neocortex but absent in brainstem.
  
  Conclusions
  
  Clinical recovery was associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system by 76 days but not clearance of detectable viral subcomponents such as nucleoprotein antigen or RNA in brain.
  
  
• Subjects:
  Article Cerebral Edema Immunology Pathology Rabies Recovery Of Function Therapy
• Source:
  Pediatr Infect Dis J. 34(5):520-528.
• Pubmed ID:
  25405805
• Pubmed Central ID:
  PMC4809748
• Document Type:
  Journal Article
• Funding:
  1R01AI093369/AI/NIAID NIH HHS/United States ; CC999999/Intramural CDC HHS/United States
• Volume:
  34
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9e0a354ea55ef8a7474fffc89c97ddaf7179a1e8fd57121de08e73069f89d7f6
• Download URL:
  https://stacks.cdc.gov/view/cdc/38658/cdc_38658_DS1.pdf
• File Type:
  [PDF - 1023.32 KB ]