Human rabies infection: Diagnosis, therapy and prevention

Human infection with rabies causes a severe viral encephalitis that is almost uniformly fatal. Human exposure to rabies occurs primarily via bite wounds from an infected animal with injection of infected saliva beneath the skin. Following any potential exposure, the physician must evaluate the likelihood that an actual rabies exposure occurred based on degree of contact and likelihood that the animal was infected. Once exposure is confirmed, postexposure prophylaxis with immunoglobulin and human rabies vaccine must be initiated immediately. If no prophylaxis is given and rabies encephalitis develops, the only available therapy is supportive care, with progression to multiorgan failure and death in essentially all cases.