Anatomic Pathology: Infectious Disease Pathology

• Rabies has decreased in incidence in the United States, and only one or two human cases are reported per year. Nonetheless, 15,000 to 40,000 people receive prophylaxis annually. In the United States, 29 confirmed human cases were reported during the period 2001 to 2011.

• In India and Sri Lanka, there are more than 3 cases of rabies per 100,000 persons per year.

• In the United States, raccoons, skunks, bats, and foxes are primary reservoirs. Dogs remain the main reservoir in the developing world, where vaccination of dogs is rarely performed. Cases of rabies transmitted through solid organ transplantation have been reported.

• When the virus reaches the brain, it can infect the cerebellum, Purkinje cells, hippocampus, and pontine nuclei. Histologically, characteristic viral inclusions in neuronal cells (Negri bodies) are a pathognomonic finding of rabies.

• After the virus reaches the central nervous system, it spreads in a centrifugal fashion to extraneural organs, such as salivary glands, gastrointestinal tract, and heart.

Blanton JD, Palmer D, Dyer J, et al: Rabies surveillance in the United States during 2010. J Am Vet Med Assoc 2011;239(6):773-783.

Jackson AC, Ye H, Phelan CC, et al: Extraneural organ involvement in human rabies. Lab Invest 1999;79(8):945-951.

Rupprecht CE, Hanlon CA, Hemachudha T: Rabies re-examined. Lancet Infect Dis 2002;2(6):327-342.

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