Rabies natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If left untreated, rabies runs its course very rapidly. Once symptoms begin to appear, the disease is almost always fatal. The acute period of disease typically ends after 2 to 10 days. Common complications of rabies include, psychosis, seizures, aphasia, muscular twitching, delirium and death. Treatment after exposure (receiving the vaccines), known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection.

Natural History

  • Rabies runs its course very rapidly throughout the body. Once symptoms begin to appear, the disease is almost always fatal.[1][2]
  • The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years.[3][4][5][6]
  • The acute period of disease typically ends after 2 to 10 days.
  • To date only six documented cases of human survival from clinical rabies have been reported and each included a history of either pre- or postexposure prophylaxis.
  • The few humans who are known to have survived the disease were all left with severe brain damage, with the recent exception of Jeanna Giese.

Complications

Common complications of rabies include:[7][8][9]

Prognosis

Treatment after exposure (receiving the vaccines), known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection. Begun with little or no delay, PEP is 100% effective against rabies.[10] In the case in which there has been a significant delay in administering PEP, the treatment should be administered regardless of that delay, as it may still be effective.

In unvaccinated humans, rabies is usually fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. Rabies kills around 55,000 people a year, mostly in Asia and Africa.[11]

Survival data using the Milwaukee protocol are available from the rabies registry.[12] As of 2011, seven people have been saved by this induced coma treatment.

References

  1. Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S, Laothamatas J (2013). "Human rabies: neuropathogenesis, diagnosis, and management". Lancet Neurol. 12 (5): 498–513. doi:10.1016/S1474-4422(13)70038-3. PMID 23602163.
  2. Hattwick MA (1972). "Reactions to rabies". N. Engl. J. Med. 287 (23): 1204. PMID 5082226.
  3. Knobel DL, Cleaveland S, Coleman PG, Fèvre EM, Meltzer MI, Miranda ME, Shaw A, Zinsstag J, Meslin FX (2005). "Re-evaluating the burden of rabies in Africa and Asia". Bull. World Health Organ. 83 (5): 360–8. doi:/S0042-96862005000500012 Check |doi= value (help). PMC 2626230. PMID 15976877.
  4. Noah DL, Drenzek CL, Smith JS, Krebs JW, Orciari L, Shaddock J, Sanderlin D, Whitfield S, Fekadu M, Olson JG, Rupprecht CE, Childs JE (1998). "Epidemiology of human rabies in the United States, 1980 to 1996". Ann. Intern. Med. 128 (11): 922–30. PMID 9634432.
  5. Rupprecht CE, Hanlon CA, Hemachudha T (2002). "Rabies re-examined". Lancet Infect Dis. 2 (6): 327–43. PMID 12144896.
  6. Boland TA, McGuone D, Jindal J, Rocha M, Cumming M, Rupprecht CE, Barbosa TF, de Novaes Oliveira R, Chu CJ, Cole AJ, Kotait I, Kuzmina NA, Yager PA, Kuzmin IV, Hedley-Whyte ET, Brown CM, Rosenthal ES (2014). "Phylogenetic and epidemiologic evidence of multiyear incubation in human rabies". Ann. Neurol. 75 (1): 155–60. doi:10.1002/ana.24016. PMC 4118733. PMID 24038455.
  7. Udwadia ZF, Udwadia FE, Katrak SM, Dastur DK, Sekhar M, Lall A, Kumta A, Sane B (1989). "Human rabies: clinical features, diagnosis, complications, and management". Crit. Care Med. 17 (8): 834–6. PMID 2752780.
  8. Bhatt DR, Hattwick MA, Gerdsen R, Emmons RW, Johnson HN (1974). "Human rabies. Diagnosis, complications, and management". Am. J. Dis. Child. 127 (6): 862–9. PMID 4600621.
  9. Tullu MS, Rodrigues S, Muranjan MN, Bavdekar SB, Kamat JR, Hira PR (2003). "Neurological complications of rabies vaccines". Indian Pediatr. 40 (2): 150–4. PMID 12626831.
  10. Jordan Lite (2008-10-08). "Medical Mystery: Only One Person Has Survived Rabies without Vaccine--But How?". Scientific American. Retrieved 2010-01-30.
  11. "Rabies". World Health Organization (WHO). September 2011. Retrieved 31 December 2011.
  12. "Rabies Registry". Medical College of Wisconsin. Retrieved 29 December 2009.

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