It is possible to provide very efficient prophylaxis against rabies encephalitis, which remains universally fatal in practice. The unique pathogenisis of this neurotropic virus is slowly being unravelled, but the relevance of the paradoxical immunological features remain mysterious. The epidemiology of rabies is being clarified because virus strains can now be classified and identified precisely. Recent developments are reviewed here; also a clinician’s view of rabies, its diagnosis, and of the patients said to have recovered from rabies encephalitis.
Rabies is a zoonosis of certain mammal species, endemic in all continents. Only a few European countries, some islands and peninsulas and Antarctica, are free of the fear of rabies, although imported infection is a universal risk. Rabies occurs in separate cycles within dogs and wild mammal vector species (see ‘Post-exposure treatment’, page 24), and the virus sometimes spills over to nonvector species such as humans. Strains of virus from
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