Herpes Simplex Virus Encephalitis and Rabies

RABIES

Humans acquire rabies from the bite of a rabid animal or from inhalation from aerosolized virus in caves inhabited by rapid bats. Two forms of classic rabies are recognized: furious rabies, which is characterized by fever, fluctuating consciousness, phobic spasms, and autonomic dysfunction, and paralytic rabies, which resembles the Guillain-Barré syndrome. Patients with bat rabies have different clinical features than those with classic rabies. Rabies acquired by the bite of a bat manifests with focal neurologic deficits, choreiform movements, myoclonus, seizures, and hallucinations. Phobic spasms are not a cardinal feature of bat rabies.

The diagnosis of rabies can be made by performing the reverse-transcriptase polymerase chain reaction (RT-PCR) on saliva, nuchal skin biopsy specimens, or CSF for rabies virus ribonucleic acid (RNA) detection. Classically, the diagnosis was made by biopsy and demonstration of cytoplasmic Negri inclusion bodies. Treatment begins with an immediate washing and flushing of the wound with soap and water and disinfecting with iodine. Rabies immunoglobulin should be infiltrated into and around the wound, and rabies vaccine is administered either intramuscularly or intradermally. Postexposure prophylaxis should not await the results of laboratory confirmation of the diagnosis.

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