title: Virology, immunology and pathology of human rabies during treatment.
abstract: BACKGROUND
  Rabies is an acute fatal encephalitis caused by all members of the Lyssavirus genus. The first human rabies survivor without benefit of prior vaccination was reported from Milwaukee in 2005. We report a second unvaccinated patient who showed early recovery from rabies and then died accidentally during convalescence, providing an unparalleled opportunity to examine the histopathology as well as immune and virological correlates of early recovery from human rabies.
  
  
  METHODS
  Case report, rapid fluorescent focus inhibition test, enzyme-linked immunosorbent assay, indirect and direct fluorescent antibody assays, reverse-transcriptase polymerase chain reaction, phylogenetic reconstruction, isolation in tissue culture, pathology and immunohistochemistry.
  
  
  RESULTS
  The 9 year old died 76 days after presenting with rabies of vampire bat phylogeny transmitted by cat bite. Antibody response in serum and cerebrospinal fluid was robust and associated with severe cerebral edema. No rabies virus was cultured at autopsy. Rabies virus antigen was atypical in size and distribution. Rabies virus genome was present in neocortex but absent in brainstem.
  
  
  CONCLUSIONS
  Clinical recovery was associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system by 76 days but not clearance of detectable viral subcomponents such as nucleoprotein antigen or RNA in brain.
authors.affiliation: From the *Hospital Universitario del Valle, Cali, Colombia; †Laboratorio de Virología, Instituto Nacional de Salud (INS), Bogotá D.C., Colombia; ‡Rabies Program, Centers for Disease Control and Prevention, Atlanta, GA; §Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA; and ¶Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Caicedo
authors.forename: Andres
authors.initials: A
authors.lastname: Paez
authors.forename: Ivan
authors.initials: I
authors.lastname: Kuzmin
authors.forename: Michael
authors.initials: M
authors.lastname: Niezgoda
authors.forename: Lillian A
authors.initials: LA
authors.lastname: Orciari
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Yager
authors.forename: Sergio
authors.initials: S
authors.lastname: Recuenco
authors.forename: Richard
authors.initials: R
authors.lastname: Franka
authors.forename: Andres
authors.initials: A
authors.lastname: Velasco-Villa
authors.forename: Rodney E
authors.initials: RE
authors.lastname: Willoughby
mesh_terms: D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D001733:Bites and Stings; D001921:Brain / Q000821:virology; D001929:Brain Edema / Q000821:virology; D002415:Cats; D002648:Child; D003105:Colombia; D004195:Disease Models, Animal; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D051379:Mice; D011818:Rabies / Q000276:immunology / Q000503:physiopathology / Q000628:therapy / Q000821:virology; D011820:Rabies virus / Q000276:immunology
chemical_list: D000914:Antibodies, Viral