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Difference in neuropathogenetic mechanisms in human furious and paralytic rabies.

Authors :
Mitrabhakdi E
Shuangshoti S
Wannakrairot P
Lewis RA
Susuki K
Laothamatas J
Hemachudha T
Source :
Journal of the neurological sciences [J Neurol Sci] 2005 Nov 15; Vol. 238 (1-2), pp. 3-10. Date of Electronic Publication: 2005 Oct 14.
Publication Year :
2005

Abstract

Whereas paralysis is the hallmark for paralytic rabies, the precise pathological basis of paralysis is not known. It is unclear whether weakness results from involvement of anterior horn cells or of motor nerve fibers. There is also no conclusive data on the cause of the neuropathic pain which occurs at the bitten region, although it has been presumed to be related to sensory ganglionopathy. In this study, six laboratory-proven rabies patients (three paralytic and three furious) were assessed clinically and electrophysiologically. Our data suggests that peripheral nerve dysfunction, most likely demyelination, contributes to the weakness in paralytic rabies. In furious rabies, progressive focal denervation, starting at the bitten segment, was evident even in the absence of demonstrable weakness and the electrophysiologic study suggested anterior horn cell dysfunction. In two paralytic and one furious rabies patients who had severe paresthesias as a prodrome, electrophysiologic studies suggested dorsal root ganglionopathy. Postmortem studies in two paralytic and one furious rabies patients, who had local neuropathic pain, showed severe dorsal root ganglionitis. Intense inflammation of the spinal nerve roots was observed more in paralytic rabies patients. Inflammation was mainly noted in the spinal cord segment corresponding to the bite in all cases; however, central chromatolysis of the anterior horn cells could be demonstrated only in furious rabies patient. We conclude that differential sites of neural involvement and possibly different neuropathogenetic mechanisms may explain the clinical diversity in human rabies.

Details

Language :
English
ISSN :
0022-510X
Volume :
238
Issue :
1-2
Database :
MEDLINE
Journal :
Journal of the neurological sciences
Publication Type :
Academic Journal
Accession number :
16226769
Full Text :
https://doi.org/10.1016/j.jns.2005.05.004