Rabies

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The rabies is known for millennia virus infection, in animals and human life-an acute encephalitis (brain inflammation). Synonyms are Wutkrankheit, Lyssa (Greek λύσσα), the Rabies (Latin) and the Rage (French). Previously, we used synonymously and the hydrophobic (water fear, a symptom). ICD 10 code: A82.9

The virus, the species most warm-blooded animals, but among non-carnivores rare. The stereotypical image of a rabid animal is aggressive dog with foaming at the mouth. But cats, ferrets, foxes, badgers, raccoons, jaw squirrels, skunks, and the Bat can be rabid or the classic rabies or any other form. Concerning the Bat are vampire bats (Desmodus rotundus or Desmodus spec.), Insektenfressenden Fledertieren usually bats (Microchiroptera) and at fruchtfressenden Fledertieren mostly flying foxes (very rarely Megachiroptera) this. Main carrier is in the European countries the fox, while in India, for example, stray dogs as a main source of infection. Squirrels, rabbits and other rodents are very rarely infected. Birds very rarely get rabies, because their body temperature is higher than for the optimum propagation of the virus is necessary. Rabies is also in a so-called "paralytischen" show, in which the infected animal unnaturally quiet and withdrawn behavior.

Between 40000 and 70000 people die of rabies each year, most of them in Asia (approx. 80% [1]) and in Eastern Europe. Half of the deaths worldwide affects children and young people under 15 years. Approximately 10 million people a year are treated for a suspected to be exposed to rabies.

Excitation
The various distinct rabies is cylindrical shaped, single behüllte (-)-strand RNA viruses (ss (-) RNA), the Lyssaviren genus of the family Rhabdoviridae causes. In all these pathogens are currently a total of seven different genotypes:

* Genotype 1: Rabiesvirus (RABV). This virus is the classic rabies virus.
* Genotype 2: Lagos-bat virus = Lagos bat virus (LBV)
* Genotype 3: Mokola virus (MOKV)
* Genotype 4: Duvenhage virus (DUVV)
* Genotypes 5 and 6: European Bat Lyssavirus = European-bat lyssavirus (EBLV 1, 2)
* Genotype 7: Australian Bat Lyssavirus = Australian-bat lyssavirus (ABLV)

These viruses usually have either a spiral or cubic symmetry. They have Lyssaviren a spiral form, ie their infectious particles have roughly cylindrical shape.

Except genotype 2 are listed above all other genotypes rabies cases in humans.

RNA viruses can be dry days and strong sunlight or by disinfectants or high temperatures, such as during the heat sterilization, inactivated.

Transfer
The virus arrives on the cranial nerves to the salivary glands of his landlord, and is in the saliva of an infected animal rabies. In general it is transmitted by a bite, but it can also have contact with the saliva of the existing small skin wounds transferred. For a transmission by droplets infection is a much higher amount necessary virus than with the transmission through wounds.

A transmission through mucous membranes is observed. Possibly a transfer happened in this form in humans, the caves populated by bats explored. Except in the case of organ transplantation (three cases in the United States at the beginning of the year 2004, and three cases in Germany in early 2005) is the transfer from one person to another in the western world in recent years has been observed. This was achieved through active vaccination of animals and the launch of diseased animals. In other countries, particularly in Asia and Africa, it always comes back to local outbreaks.


Disease course and symptoms


Disease process in humans
After infection of a man by the bite of an infected animal remains the virus for about three days in the vicinity of the entrance gate, and there are increasingly then reached on the inside of the nerve fibers of the peripheral nerves to the spinal cord and eventually to the brain. From the central nervous system of spreading the virus along peripheral nerves and brain nerves, among other things, to salivary glands and tear glands and their secretions with Ret. [3] Is the virus by the bite directly into the bloodstream reaches, it reaches the central nervous system much faster. Only during the more or less long early stage, so in the first few hours, there is still a sense postexpositionelle vaccination. Once the virus reaches the brain, is a vaccination is no longer effective.

The incubation period - the period between the infection and the first symptoms grippeartigen - can take up to two years, but it is usually 3 to 12 days. There were also, however, incubation periods of up to 10 years credibly explained.

The virus causes encephalitis (brain inflammation), then what the typical symptoms appear. It can also affect the spinal cord, resulting in a myelitis (myelitis) expresses. The transmission through a bite in arm or leg is often expressed pain at the first gebissenen extremities. Sensitivity to the loss Hautdermatome is regularly monitored. Therefore, many, especially atypical disease progression first as Guillain-Barre syndrome wrongly. Soon thereafter increase the central nervous symptoms like paralysis, fear, confusion, excitement, then progressing to delirium, abnormal behavior, hallucinations and insomnia. The paralysis of the posterior cranial nerves (glossopharyngeal nerve, vagus nerve) leads to a throat paralysis, coupled with an inability to speak (in the case of dogs' barking heiseres "), or to swallow - this is during late stages of the disease typical. The sight of water can seizures with spasms of the larynx and pharynx cause. The saliva production can no longer be abgeschluckt and foam forms before mouth or foot. The hydrophobic and swallowing disability prevent the dilution of the virus, which increased its virulence. Slightest environmental stimuli, noise, light lead to Wutanfällen, yelling, hitting and biting, with the - high - finally virus is transmitted.

The disease may also be in the "silent" form run, in which a portion of the above symptoms is missing. However, regardless of the form in the course of MRI imaging with a brightening in the region of the hippocampus and nucleus Caudatus. Almost always occurs 2 to 10 days after the first symptoms of death. With the exception of the child Jeanna Giese, the few survivors heaviest brain damage.


Disease progression in animals
An rabies, all mammals and birds also caused disease. The incubation period is normally 2 to 8 weeks. The illness lasts between one day and one week, and ends almost always fatal. The disease often begins with essential changes.

House afflicted dogs can be very aggressive and ironically, are übererregt, show an increased sex drive and unmotivated bark ( "raging anger"). Later, paralysis, which heiserem barking, swallowing disorders (strong salivation, foam front of the mouth), the tongue hanging out and resulting paralysis of the hind legs, it is hard to property. The phase of the "raging anger" might be missing, and the rabies with the same symptoms begin paralysis ( "quiet anger"). There are also atypical histories, the first of a gastro-intestinal inflammation channel (gastroenteritis) the same.

The house cat resembles the clinical picture of the dog. Frequently runs a diseased cat, and caterwauls constantly responding aggressively to irritation. During the final stage there will be paralysis.

When beef house shows a rabies usually first in digestive disorders, it comes at a Atonie and Aufgasung the rumen and diarrhoea. Especially in the case of grazing must always rabies as a possible cause of digestive disorders to be considered. Later arose muscle twitching, salivation, constant roar and paralysis of the rear legs. For small ruminants, such as sheep and goats dominates the "quiet anger", it can also unrest, and a constant Blöken increased sex drive.

At home, the horse rabies as a "raging anger" race against stall walls and colic or as a "quiet anger" with apathy. The "quiet anger" can be likened to a disease Bornaschen confused.

When pigs dominate excitement, persistent heiseres grunting, forced movements and Beißwut.

In birds, the disease is very rare and is expressed in ängstlichem beep sounds, movement disorders and paralysis.

When a wild animal rabies often leads to the loss of awe of the man. However, it should be noted that many urbanized wild animals such as raccoons and Füche this is not any more.

Therapy
There is no known cure for rabies. After an infection, and exceeding the time limit for a post-exposure prophylaxis was Elle recent treatment with antiviral drugs, antivirals, and zeitgleichem artificial coma to reduce metabolic tries. This therapy experiments, however, were not successful, because only a few patients a treatment with serious brain damage survived. The first man, an experimental therapy after such an infection largely without serious damage has survived, the American woman Jeanna Giese. On 12 May 2006 a young person died in Houston, Texas, to rabies as a result of a Fledermausbisses, although this experimental therapy has been applied.

Myth and History
In earlier times was the rabies myths, superstitions and errors surrounded stoked, as the disease inevitably led to death, the fears and fantasies of people. Also, that the supposedly rabies transmitted by wolves, contributed to the legend formation, the origin of Werwolfsglaubens example, possibly rooted in a human rabies disease. Even in ancient times, and Aristotle dealt with the disease Euripides, Greek gods in the world were Artemis, Hecate, and Actaeon Lycaon Herald, distributors or victims of rabies. Sirius, the main star in the constellation of the Great dog, owes its name to the legend, a pioneer of the disease to be in the middle of summer - to the dog days (in which Sirius in the vicinity of the Sun; we took earlier, the sun and Sirius would work together in this time) -- were dogs, the man with the spread of rabies in connection brought tortured and sacrificed. In the Middle Ages, starting from St. Augustine, the origin of rabies at the devil sought the holy Hubertus true since that time as the patron saint against rabies.

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