Virology, immunology and pathology of human rabies during treatment

Yolanda Caicedo, Andres Paez, Ivan Kuzmin, Michael Niezgoda, Lillian A. Orciari, Pamela A. Yager, Sergio Recuenco, Richard Franka, Andres Velasco-Villa, Rodney E. Willoughby

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Rabies is an acute fatal encephalitis caused by all members of the Lyssavirus genus. The first human rabies survivor without benefit of prior vaccination was reported from Milwaukee in 2005. We report a second unvaccinated patient who showed early recovery from rabies and then died accidentally during convalescence, providing an unparalleled opportunity to examine the histopathology as well as immune and virological correlates of early recovery from human rabies. Methods: Case report, rapid fluorescent focus inhibition test, enzyme-linked immunosorbent assay, indirect and direct fluorescent antibody assays, reverse-transcriptase polymerase chain reaction, phylogenetic reconstruction, isolation in tissue culture, pathology and immunohistochemistry. Results: The 9 year old died 76 days after presenting with rabies of vampire bat phylogeny transmitted by cat bite. Antibody response in serum and cerebrospinal fluid was robust and associated with severe cerebral edema. No rabies virus was cultured at autopsy. Rabies virus antigen was atypical in size and distribution. Rabies virus genome was present in neocortex but absent in brainstem. Conclusions: Clinical recovery was associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system by 76 days but not clearance of detectable viral subcomponents such as nucleoprotein antigen or RNA in brain.

Original languageEnglish
Pages (from-to)520-528
Number of pages9
JournalPediatric Infectious Disease Journal
Issue number5
StatePublished - 21 May 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc.


  • cerebral edema
  • immunology
  • pathology
  • rabies
  • recovery of function
  • therapy


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