Cited by 446Rabies epidemiology and controlInfectious Encephalopathies and EncephalitisVirology and Viral Diseases

Human rabies: neuropathogenesis, diagnosis, and management

Hemachudha, Thiravat, Ugolini, Gabriella, Wacharapluesadee, Supaporn, Sungkarat, Witaya, Shuangshoti, Shanop, Laothamatas, Jiraporn·2013·The Lancet Neurology

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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Crossref · 10.1016/s1474-4422(13)70038-3

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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
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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