Features and treatment of rabies

The epidemiology, virology, transmission, pathology, clinical manifestations, diagnosis, and treatment of rabies infection are described. The incidence of rabies is increasing. The virus is usually transmitted through the bite of an infected animal; however, corneal transplantation from an infected donor and viral inhalation may also result in infection. The clinical course of rabies occurs in five stages. Stage I is the incubation period, stage II is the prodromal period, stage III is the neurological period, stage IV is coma, and stage V, which occurs infrequently, is recovery. Early in the disease, constitutional symptoms and signs of local wound healing may be present. During the later stages, a wide array of clinical manifestations may occur, including hydrophobia and aerophobia, which are pathognomonic for rabies. Once inoculation with the rabies virus is suspected, prompt therapy, including appropriate wound care and rabies vaccination, is imperative, even in previously immunized individuals. Human diploid-cell vaccine and rabies vaccine adsorbed, which stimulate the production of antibodies, and human rabies immune globulin, which provides protective antibodies, are nearly 100% effective in preventing progression from stage I disease. If left untreated, rabies is usually fatal. However, treatment with human diploid-cell vaccine or rabies vaccine adsorbed and with human rabies immune globulin is nearly always curative if initiated early in the incubation period.