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Pathophysiologic studies in human rabies

D A Warrell, N M Davidson, H M Pope

    The American Journal of Medicine
    |February 1, 1976
    PubMed
    Summary
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    Rabies causes severe brainstem encephalitis and respiratory failure, leading to death even with intensive care. Management focuses on reducing suffering through sedation, especially in developing nations.

    Area of Science:

    • Neurology
    • Infectious Diseases
    • Pathology

    Background:

    • Rabies is a viral zoonotic disease that causes acute encephalitis, invariably fatal once clinical symptoms appear.
    • Understanding the clinical, physiological, and pathological aspects of rabies is crucial for improving patient management and outcomes.

    Observation:

    • Inspiratory muscle spasm, a hallmark of hydrophobia, was the primary clinical manifestation across all six patients.
    • Patients exhibited various breathing abnormalities, including periodic and ataxic patterns, alongside supraventricular arrhythmias in some cases.
    • Autopsies revealed widespread brainstem encephalitis, particularly affecting the nucleus ambiguus region, and in one case, severely reduced cerebral oxygen consumption.

    Findings:

    • Respiratory failure was the primary cause of death in three patients receiving intensive care.

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  • Myocarditis and rabies virus presence in the myocardium were noted in patients with arrhythmias.
  • Encephalitis, specifically brainstem involvement, was identified as the ultimate factor hindering survival.

    • Implications:

    • The study highlights the critical role of severe encephalitis in rabies pathogenesis and patient mortality.
    • Current intensive care approaches have limited success in preventing fatal outcomes.
    • In resource-limited settings, palliative care focusing on sedation is the most feasible clinical management strategy for rabies patients.