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Alexander B, Lopez-Lopez JP, Saldarriaga C, Ponte-Negretti CI, Lopez-Santi R, Perez GE, del Sueldo M, Lanas F, Liblik K, Baranchuk A. Rabies and the Heart. Cardiol Res 2021; 12:53-59. [PMID: 33738007 PMCID: PMC7935633 DOI: 10.14740/cr1216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
As one of the neglected diseases, rabies is as a highly fatal viral infection, most prevalent in low- and middle-income regions, which produces a substantial health and economic burden. It mainly affects the central nervous system causing encephalitis, however extraneuronal involvement has been documented. Cardiac structures may be involved and can play a role in the severity of the disease. Most of the existing literature comes from case reports and case series where cardiac involvement results in myocarditis and cardiac arrhythmias. As part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (NET-HEART Project), the objective of this article is to review all the information available on the cardiac involvement of this disease.
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Affiliation(s)
- Bryce Alexander
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, ON, Canada
| | - Jose Patricio Lopez-Lopez
- Centro Integral para la Prevencion de Enfermedades Cardiometabolicas (CIPCA) and Instituto de Investigaciones Masira, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica Cardiovascular Santa Maria, Universidad of Antioquia, Medellin, Colombia
| | | | - Ricardo Lopez-Santi
- Division of Cardiology, Hospital Italiano de La Plata, Buenos Aires, Argentina
| | | | | | | | - Kiera Liblik
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, ON, Canada
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Gossner CM, Mailles A, Aznar I, Dimina E, Echevarría JE, Feruglio SL, Lange H, Maraglino FP, Parodi P, Perevoscikovs J, Van der Stede Y, Bakonyi T. Prevention of human rabies: a challenge for the European Union and the European Economic Area. Euro Surveill 2020; 25:2000158. [PMID: 32975184 PMCID: PMC7533618 DOI: 10.2807/1560-7917.es.2020.25.38.2000158] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
Rabies is enzootic in over one hundred countries worldwide. In the European Union/European Economic Area (EU/EEA), the vast majority of human rabies cases are travellers bitten by dogs in rabies-enzootic countries, mostly in Asia and Africa. Thus, EU/EEA travellers visiting rabies enzootic countries should be aware of the risk of being infected with the rabies virus when having physical contact with mammals. They should consider pre-exposure vaccination following criteria recommended by the World Health Organization and if unvaccinated, immediately seek medical attention in case of bites or scratches from mammals. As the majority of the EU/EEA countries are free from rabies in mammals, elimination of the disease (no enzootic circulation of the virus and low number of imported cases) has been achieved by 2020. However, illegal import of potentially infected animals, mainly dogs, poses a risk to public health and might threaten the elimination goal. Additionally, newly recognised bat lyssaviruses represent a potential emerging threat as the rabies vaccine may not confer protective immunity. To support preparedness activities in EU/EEA countries, guidance for the assessment and the management of the public health risk related to rabies but also other lyssaviruses, should be developed.
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Affiliation(s)
- Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Inma Aznar
- European Food Safety Authority (EFSA), Parma, Italy
| | - Elina Dimina
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Juan E Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Heidi Lange
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | - Tamás Bakonyi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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3
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Carod-Artal FJ. Infectious diseases causing autonomic dysfunction. Clin Auton Res 2017; 28:67-81. [PMID: 28730326 DOI: 10.1007/s10286-017-0452-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review infectious diseases that may cause autonomic dysfunction. METHODS Review of published papers indexed in medline/embase. RESULTS Autonomic dysfunction has been reported in retrovirus (human immunodeficiency virus (HIV), human T-lymphotropic virus), herpes viruses, flavivirus, enterovirus 71 and lyssavirus infections. Autonomic dysfunction is relatively common in HIV-infected patients and heart rate variability is reduced even in early stages of infection. Orthostatic hypotension, urinary dysfunction and hypohidrosis have been described in tropical spastic paraparesis patients. Varicella zoster reactivation from autonomic ganglia may be involved in visceral disease and chronic intestinal pseudo-obstruction. Autonomic and peripheral nervous system dysfunction may happen in acute tick-borne encephalitis virus infections. Hydrophobia, hypersalivation, dyspnea, photophobia, and piloerection are frequently observed in human rabies. Autonomic dysfunction and vagal denervation is common in Chagas disease. Neuronal depopulation occurs mainly in chagasic heart disease and myenteric plexus, and megacolon, megaesophagus and cardiomyopathy are common complications in the chronic stage of Chagas disease. Parasympathetic autonomic dysfunction precedes left ventricle systolic dysfunction in Chagas disease. A high prevalence of subclinical autonomic neuropathy in leprosy patients has been reported, and autonomic nerve dysfunction may be an early manifestation of the disease. Autonomic dysfunction features in leprosy include anhidrosis, impaired sweating function, localised alopecia ,and reduced heart rate variability. Urinary retention and intestinal pseudo-obstruction have been described in Lyme disease. Diphtheritic polyneuropathy, tetanus and botulism are examples of bacterial infections releasing toxins that affect the autonomic nervous system. CONCLUSIONS Autonomic dysfunction may be responsible for additional morbidity in some infectious diseases.
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Affiliation(s)
- Francisco Javier Carod-Artal
- Neurology Department, Raigmore Hospital, Inverness, UK. .,Health Sciences Faculty, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
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Lampejo T, Bruce M, Teall A, Dall'Antonia M, Crawley-Boevey E, Grant P, Polhill S, Pillay D, Brown D, Brown M, Nastouli E. Caring for a patient with rabies: implications of the Milwaukee protocol for infection control and public health measures. J Hosp Infect 2017; 96:385-391. [PMID: 28559126 DOI: 10.1016/j.jhin.2017.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/21/2017] [Indexed: 12/25/2022]
Abstract
This article discusses the infection control and public health measures taken whilst managing a case of laboratory-confirmed rabies, and the challenges faced in implementing these measures. Case management requires intensive multi-disciplinary co-ordination. The Milwaukee protocol, which to date has five reported human rabies survivors associated with its use, has been suggested as a potential management pathway for human rabies. Consensus among hospital and public health clinicians would aid future deployment of this approach in selected cases.
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Affiliation(s)
- T Lampejo
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK.
| | - M Bruce
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Teall
- Department of Clinical Microbiology, Queen Elizabeth Hospital NHS Trust, Woolwich, London, UK
| | - M Dall'Antonia
- Department of Clinical Microbiology, Queen Elizabeth Hospital NHS Trust, Woolwich, London, UK
| | | | - P Grant
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Polhill
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - D Pillay
- Department of Infection and Immunity, University College London, London, UK
| | - D Brown
- Public Health England, Colindale, Viral Zoonosis Unit, London, UK
| | - M Brown
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - E Nastouli
- Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Rupprecht C, Kuzmin I, Meslin F. Lyssaviruses and rabies: current conundrums, concerns, contradictions and controversies. F1000Res 2017; 6:184. [PMID: 28299201 PMCID: PMC5325067 DOI: 10.12688/f1000research.10416.1] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/20/2022] Open
Abstract
Lyssaviruses are bullet-shaped, single-stranded, negative-sense RNA viruses and the causative agents of the ancient zoonosis rabies. Africa is the likely home to the ancestors of taxa residing within the Genus Lyssavirus, Family Rhabdoviridae. Diverse lyssaviruses are envisioned as co-evolving with bats, as the ultimate reservoirs, over seemingly millions of years. In terms of relative distribution, overt abundance, and resulting progeny, rabies virus is the most successful lyssavirus species today, but for unknown reasons. All mammals are believed to be susceptible to rabies virus infection. Besides reservoirs among the Chiroptera, meso-carnivores also serve as major historical hosts and are represented among the canids, raccoons, skunks, mongooses, and ferret badgers. Perpetuating as a disease of nature with the mammalian central nervous system as niche, host breadth alone precludes any candidacy for true eradication. Despite having the highest case fatality of any infectious disease and a burden in excess of or comparative to other major zoonoses, rabies remains neglected. Once illness appears, no treatment is proven to prevent death. Paradoxically, vaccines were developed more than a century ago, but the clear majority of human cases are unvaccinated. Tens of millions of people are exposed to suspect rabid animals and tens of thousands succumb annually, primarily children in developing countries, where canine rabies is enzootic. Rather than culling animal populations, one of the most cost-effective strategies to curbing human fatalities is the mass vaccination of dogs. Building on considerable progress to date, several complementary actions are needed in the near future, including a more harmonized approach to viral taxonomy, enhanced de-centralized laboratory-based surveillance, focal pathogen discovery and characterization, applied pathobiological research for therapeutics, improved estimates of canine populations at risk, actual production of required vaccines and related biologics, strategies to maximize prevention but minimize unnecessary human prophylaxis, and a long-term, realistic plan for sustained global program support to achieve success in disease control, prevention, and elimination.
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Affiliation(s)
| | - Ivan Kuzmin
- University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA
| | - Francois Meslin
- DVM, former Team Leader, Neglected Zoonotic Diseases, WHO Headquarters, Geneva, Switzerland
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Schnee M, Vogel AB, Voss D, Petsch B, Baumhof P, Kramps T, Stitz L. An mRNA Vaccine Encoding Rabies Virus Glycoprotein Induces Protection against Lethal Infection in Mice and Correlates of Protection in Adult and Newborn Pigs. PLoS Negl Trop Dis 2016; 10:e0004746. [PMID: 27336830 PMCID: PMC4918980 DOI: 10.1371/journal.pntd.0004746] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/06/2016] [Indexed: 12/18/2022] Open
Abstract
Rabies is a zoonotic infectious disease of the central nervous system (CNS). In unvaccinated or untreated subjects, rabies virus infection causes severe neurological symptoms and is invariably fatal. Despite the long-standing existence of effective vaccines, vaccine availability remains insufficient, with high numbers of fatal infections mostly in developing countries. Nucleic acid based vaccines have proven convincingly as a new technology for the fast development of vaccines against newly emerging pathogens, diseases where no vaccine exists or for replacing already existing vaccines. We used an optimized non-replicating rabies virus glycoprotein (RABV-G) encoding messenger RNA (mRNA) to induce potent neutralizing antibodies (VN titers) in mice and domestic pigs. Functional antibody titers were followed in mice for up to one year and titers remained stable for the entire observation period in all dose groups. T cell analysis revealed the induction of both, specific CD4+ as well as CD8+ T cells by RABV-G mRNA, with the induced CD4+ T cells being higher than those induced by a licensed vaccine. Notably, RABV-G mRNA vaccinated mice were protected against lethal intracerebral challenge infection. Inhibition of viral replication by vaccination was verified by qRT-PCR. Furthermore, we demonstrate that CD4+ T cells are crucial for the generation of neutralizing antibodies. In domestic pigs we were able to induce VN titers that correlate with protection in adult and newborn pigs. This study demonstrates the feasibility of a non-replicating mRNA rabies vaccine in small and large animals and highlights the promises of mRNA vaccines for the prevention of infectious diseases.
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Affiliation(s)
| | | | | | | | | | | | - Lothar Stitz
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
- * E-mail: (BP); (LS)
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Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned. Can J Neurol Sci 2015; 43:44-51. [PMID: 26639059 DOI: 10.1017/cjn.2015.331] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Milwaukee protocol has been attributed to survival in rabies encephalitis despite a lack of scientific evidence supporting its therapeutic measures. We have reviewed the literature with reference to specific treatment recommendations made within the protocol. Current literature fails to support an important role for excitotoxicity and cerebral vasospasm in rabies encephalitis. Therapies suggested in the Milwaukee protocol include therapeutic coma, ketamine infusion, amantadine, and the screening/prophylaxis/management of cerebral vasospasm. None of these therapies can be substantiated in rabies or other forms of acute viral encephalitis. Serious concerns over the current protocol recommendations are warranted. The recommendations made by the Milwaukee protocol warrant serious reconsideration before any future use of this failed protocol.
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Affiliation(s)
- Alan C Jackson
- Departments of Internal Medicine (Neurology) and of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
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