RESUMO
The direct fluorescent antibody test (DFA), is performed in all rabies reference laboratories across Latin America and the Caribbean (LAC). Despite DFA being a critical capacity in the control of rabies, there is not a standardized protocol in the region. We describe the results of the first inter-laboratory proficiency exercise of national rabies laboratories in LAC countries as part of the regional efforts towards dog-maintained rabies elimination in the American region. Twenty three laboratories affiliated to the Ministries of Health and Ministries of Agriculture participated in this exercise. In addition, the laboratories completed an online questionnaire to assess laboratory practices. Answers to the online questionnaire indicated large variability in the laboratories throughput, equipment used, protocols availability, quality control standards and biosafety requirements. Our results will inform actions to improve and harmonize laboratory rabies capacities across LAC in support for the regional efforts towards elimination of dog-maintained rabies.
Assuntos
Doenças do Cão/diagnóstico , Ensaio de Proficiência Laboratorial/normas , Saúde Pública , Vírus da Raiva/imunologia , Raiva/diagnóstico , Animais , Encéfalo/virologia , Região do Caribe , Erradicação de Doenças , Doenças do Cão/prevenção & controle , Doenças do Cão/virologia , Cães , Técnica Direta de Fluorescência para Anticorpo , Humanos , Cooperação Internacional , Internet , América Latina , Controle de Qualidade , Raiva/prevenção & controle , Raiva/virologia , Vírus da Raiva/isolamento & purificação , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
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.
Assuntos
Raiva , Animais , Anticorpos Antivirais/sangue , Mordeduras e Picadas , Encéfalo/virologia , Edema Encefálico/virologia , Gatos , Criança , Colômbia , Modelos Animais de Doenças , Evolução Fatal , Feminino , Humanos , Camundongos , Raiva/imunologia , Raiva/fisiopatologia , Raiva/terapia , Raiva/virologia , Vírus da Raiva/imunologiaRESUMO
Eight years after emigrating from Brazil, an otherwise healthy man developed rabies. An exposure prior to immigration was reported. Genetic analysis revealed a canine rabies virus variant found only in the patient's home country, and the patient had not traveled internationally since immigrating to the United States. We describe how epidemiological, phylogenetic, and viral sequencing data provided confirmation that rabies encephalomyelitis may present after a long, multiyear incubation period, a consideration that previously has been hypothesized without the ability to exclude a more recent exposure. Accordingly, rabies should be considered in the diagnosis of any acute encephalitis, myelitis, or encephalomyelitis.