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Pathogenesis and Pathology of Rabies Virus

المؤلف:  Stefan Riedel, Jeffery A. Hobden, Steve Miller, Stephen A. Morse, Timothy A. Mietzner, Barbara Detrick, Thomas G. Mitchell, Judy A. Sakanari, Peter Hotez, Rojelio Mejia

المصدر:  Jawetz, Melnick, & Adelberg’s Medical Microbiology

الجزء والصفحة:  28e , p625

2026-01-10

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Rabies virus multiplies in muscle or connective tissue at the site of inoculation and then enters peripheral nerves at neuromuscular junctions and spreads up the nerves to the central nervous system. However, it is also possible for rabies virus to enter the nervous system directly without local replication. It multiplies in the central nervous system and progressive encephalitis develops. The virus then spreads through peripheral nerves to the salivary glands and other tissues. The organ with the highest titers of virus is the submaxillary salivary gland. Other organs where rabies virus has been found include pancreas, kidney, heart, retina, and cornea. Rabies virus has not been isolated from the blood of infected persons.

Susceptibility to infection and the incubation period may depend on the host’s age, genetic background, and immune status, the viral strain involved, the amount of inoculum, the severity of lacerations, and the distance the virus has to travel from its point of entry to the central nervous system. There is a higher attack rate and shorter incubation period in persons bitten on the face or head; the lowest mortality occurs in those bitten on the legs.

Rabies virus produces a specific eosinophilic cytoplasmic inclusion, the Negri body, in infected nerve cells. Negri bodies are filled with viral nucleocapsids. The presence of such inclusions is pathognomonic of rabies but is not observed in at least 20% of cases. Therefore, the absence of Negri bodies does not rule out rabies as a diagnosis. The importance of Negri bodies in rabies diagnosis has been lessened by the development of the more sensitive fluorescent antibody and reverse transcription polymerase chain reaction diagnostic tests.