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Rabies encephalitis in a patient with AIDS: a clinicopathological study
H Adle-Biassette1, H Bourhy, M Gisselbrecht
1Département de Pathologie (Neuropathologie), Hôpital Henri Mondor, Créteil, France.
Acta Neuropathologica
|October 1, 1996
Summary
Rabies encephalitis occurred in an immunocompromised patient with advanced Human Immunodeficiency Virus (HIV) infection. Despite treatment, the patient died, highlighting the need for complete rabies post-exposure prophylaxis in all individuals, especially those with weakened immune systems.
Area of Science:
- Neurology
- Virology
- Immunology
Background:
- Rabies is a viral zoonotic disease transmitted through animal bites, primarily affecting the central nervous system.
- Human Immunodeficiency Virus (HIV) infection leads to progressive T-cell mediated immunosuppression, increasing susceptibility to opportunistic infections.
- The co-occurrence of rabies and HIV presents unique clinical and pathological challenges.
Observation:
- A 46-year-old male with incomplete rabies vaccination and advanced HIV (CD4 count 70/mm3) presented with rabies symptoms including fever, diarrhea, confusion, hydrophobia, and hypersialorrhea.
- Despite rabies serotherapy and vaccination, the patient rapidly deteriorated and died.
- Neuropathological examination revealed rabies encephalitis with diffuse Negri bodies, minimal inflammation, and neuronal apoptosis near inflammatory foci, but not in areas with abundant viral inclusions.
Findings:
- The neuropathology indicated unusually abundant viral multiplication and a weak inflammatory response, potentially due to T-cell mediated immunosuppression from HIV.
- Apoptosis was observed in proximity to inflammatory foci, suggesting a localized immune response to the virus.
- No concurrent HIV encephalitis or opportunistic infections were identified, indicating rabies as the primary cause of neurological decline.
Implications:
- This case underscores the critical importance of complete rabies post-exposure prophylaxis, including vaccines and immunoglobulins, for all individuals at risk, particularly immunocompromised patients.
- The findings suggest that HIV-induced immunosuppression may alter the typical inflammatory response in rabies encephalitis, leading to increased viral replication.
- Rabies encephalitis in the context of AIDS, while seemingly a random association, may not be exceptional given the global prevalence of both diseases and the increasing spread of the HIV epidemic worldwide.