The diagnosis of rabies is frequently made postmortem. This occurs because of the rarity of the disease, the increasing numbers of persons without an obvious exposure, and clinical confusion with other disorders. Important clues to diagnosis include a history of an animal bite and the development of the pathognomonic signs of hydrophobia and aerophobia. Tetanus should not be confused with rabies, because in tetanus the mental status is usually normal and the cerebrospinal fluid is normal. Other diseases that may be confused with rabies include poliomyelitis, Guillain-Barre syndrome, transverse myelitis, postvaccinial encephalomyelitis, intracranial mass lesions, cerebrovascular accidents, and poisoning with atropine-like compounds.
During the incubation period of rabies, no diagnostic test is available for either animals or persons that will indicate infection. Routine laboratory tests are of limited value for the diagnosis of rabies. Specific tests are required to diagnose rabies. Because no single test is uniformly informative, a battery of tests is commonly recommended. Early in the course of illness, the most reliable diagnostic test is a nuchal skin biopsy with immunofluorescent rabies antibody staining. Once clinical symptoms develop, a brain biopsy is universally positive when properly stained, but the invasive nature of this test precludes routine use. RFFIT may be performed on serum to detect rabies antibodies. However, while serum antibody may be present as early as day 5 of clinical illness, it may be absent after 10 to 14 days or more. Rabies virus has been isolated antemortem from human saliva, brain tissue, cerebrospinal fluid, urine, and tracheal secretions. Recently, nested PCR of RNA extracted from saliva has been shown to be a sensitive test. However, further study is required before this test can replace virus isolation as a standard antemortem diagnostic test.
No specific therapy exists to treat rabies. Treatment is directed at the clinical complications of the disease. 9 CHAPTER REFERENCES
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