title: 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.
authors.affiliation: WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. fmedthm@gmail.com
authors.forename: Thiravat
authors.initials: T
authors.lastname: Hemachudha
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ugolini
authors.forename: Supaporn
authors.initials: S
authors.lastname: Wacharapluesadee
authors.forename: Witaya
authors.initials: W
authors.lastname: Sungkarat
authors.forename: Shanop
authors.initials: S
authors.lastname: Shuangshoti
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Laothamatas
mesh_terms: D001921:Brain / Q000473:pathology*; D006801:Humans; D011818:Rabies / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D011820:Rabies virus / Q000276:immunology*