Human rabies: neuropathogenesis, diagnosis, and management
Abstract
Rabies is an almost invariably fatal disease that can present as classic furious rabies or paralytic rabies. Recovery has been reported in only a few patients, most of whom were infected with bat rabies virus variants, and has been associated with promptness of host immune response and spontaneous (immune) virus clearance. Viral mechanisms that have evolved to minimise damage to the CNS but enable the virus to spread might explain why survivors have overall good functional recovery. The shorter survival of patients with furious rabies compared with those with paralytic rabies closely corresponds to the greater amount of virus and lower immune response in the CNS of patients with the furious form. Rabies virus is present in the CNS long before symptom onset: subclinical anterior horn cell dysfunction and abnormal brain MRI in patients with furious rabies are evident days before brain symptoms develop. How the virus produces its devastating effects and how it selectively impairs behaviour in patients with furious rabies and the peripheral nerves of patients with paralytic rabies is beginning to be understood. However, to develop a pragmatic treatment strategy, a thorough understanding of the neuropathogenetic mechanisms is needed.
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Death commonly follows within an average survival time between 6 and 11 days after first symptomatic onset for furious or paralytic forms, leaving little time and extremely limited therapeutic options.
“While incubation phases vary, death commonly follows within an average survival time between 6 and 11 days after first symptomatic onset for furious or paralytic forms, respectively, thus leaving little time and extremely limited therapeutic options [1,2].”
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“While incubation phases vary, death commonly follows within an average survival time between 6 and 11 days after first symptomatic onset for furious or paralytic forms, respectively, thus leaving little time and extremely limited therapeutic options [1,2].”
BackgroundPathak, S., Horton, D. L., Lucas, S., Brown, D., Quaderi, S., Polhill, S., Walker, D., Nastouli, E., Núñez, A., Wise, E. L., et al. (2014) · Virology Journal · doi:10.1186/1743-422x-11-63 · Cited by 19 · see citing works
- Authors
- Hemachudha, T., Ugolini, G., Wacharapluesadee, S., Sungkarat, W., Shuangshoti, S., & Laothamatas, J.
- Affiliations
- Chulalongkorn University (TH)
- Centre National de la Recherche Scientifique (FR)
- Mahidol University (TH)
- Corresponding author
- Hemachudha, Thiravat
- ORCID
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 12
- Issue
- 5
- Pages
- 498-513
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W2032972474
- Cited by
- 446
- References
- 155
- Citations by year
- 2026: 38 · 2025: 47 · 2024: 37 · 2023: 42 · 2022: 37 · 2021: 33 · 2020: 37 · 2019: 20 · 2018: 34 · 2017: 37 · 2016: 31 · 2015: 24 · 2014: 21 · 2013: 6 · 2012: 1
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Virology › Rabies epidemiology and control
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Keywords
- rabies, neuropathogenesis, paralytic rabies, rabies virus, immune response, brain MRI, functional recovery, rabies diagnosis, rabies treatment
- MeSH terms
- Brain, Humans, Rabies, Rabies virus
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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