Rabies encephalitis in a patient with AIDS: a clinicopathological study

Abstract

A 46-year-old man was bitten by a dog in Mali; anti-rabies vaccination was incomplete. Three months later he was admitted to hospital with fever and diarrhea. Human immunodeficiency virus (HIV) serology was positive and CD4 count was 70/mm3. His status worsened rapidly with confusion hydrophobia and hypersialorrhea. Despite anti-rabies serotherapy and vaccination, he died suddenly 12 days after admission. Immunofluorescence on cerebral tissue samples established rabies encephalitis. Neuropathology showed mild encephalitis with occasional Babès nodules and rare perivascular mononuclear cuffs. Intraneuronal Negri inclusion bodies were remarkably diffuse and abundant. They were clearly demonstrated by immunocytochemistry and electron microscopy. Apoptotic neurons were identified in the brain stem and hippocampus in the vicinity of inflammatory foci. In contrast, apoptosis could not be demonstrated in non-inflammatory areas, even where Negri bodies were numerous. There was no associated HIV encephalitis or opportunistic infection. The occurrence of rabies encephalitis in AIDS represents a random association, but is probably not exceptional as rabies is endemic in many countries and the AIDS epidemic is spreading worldwide. In this case, although the incubation duration and clinical presentation were comparable to those in classical rabies the T-cell-mediated immunosuppression may account for the weak inflammatory reaction and unusually abundant viral multiplication. This observation confirms that all those at risk for rabies, particularly immunocompromised patients, should receive complete anti-rabies treatment including vaccines and specific immunoglobulins, as soon as possible after infection.

Reactivation of Nedd-2, a developmentally down-regulated apoptotic gene, in apoptosis induced by a street strain of rabies virus

“…The present study demonstrated that infection with a primary isolate of a street strain of rabies virus also induced apoptotic death. These data strengthen a previous report in which apoptotic neurons were found in the hippocampus and brain stem of a patient with AIDS who developed rabies, and suggest that in that case report, apoptosis was at least partly due to rabies virus induction rather than being caused by HIV alone [5]. This evidence demonstrates that apoptotic death of neurons occurs during natural infection by rabies virus.…”

Rhabdoviruses and Apoptosis

“…This case study involved a 46-year-old man who was infected with rabies virus through a dog bite [63]. The man was found to be HIV-1 positive at the time of presentation.…”

Demographics and management of dog bite victims at a level two hospital in KwaZulu-Natal

“…Only one paper has been published on this subject, in which a patient in Mali presented atypically with encephalitis following a dog bite. 4 Therefore in areas such as KZN, where HIV is epidemic, high diagnostic suspicion for rabies is needed when dealing with the demographic groups who are more likely to have sustained dog bites.…”