1. Rabies, Slow Virus Infections and Prions
Chapter 42

2. Rhabdoviruses Features Bullet-shaped (75 x 180 nm) Enveloped
Single stranded RNA genome, 12 kb
Many viruses with broad host ranges
Classification
Family Rhabdoviridae
Genus Lyssavirus (including Rabies virus)
Vertebrates
Invertebrates
Plants
Genus Vesiculovirus (Vesicular stomatitis-like viruses)

3. Rabies Virus Rabies virus replication
Spike protein mediates attachment (nicotinic acetylcholine receptor)
Viral RNA polymerase transcribes a monocistronic mRNA
Five polypeptides are encoded by the genome N
L (polymerase)
P (polymerase) M G
The N assembles with the polymerase and RNA in progeny virus (spiral configuration)
Virus exits by budding
G protrudes from plasma membrane
M binds to inner PM leaflet

4. Rabies Virus Animal susceptibility
All warm-blooded animals can be infected with varying susceptibility
High - wolves, coyotes, foxes, dogs
Intermediate - skunks, raccoons, bats
Low - opossums
Virus occurs in saliva, nervous system, urine, lymph, milk
Recovery is rare and only occurs in bats; fatal in nearly all others
Vampire bats can transmit virus for months

5. Rabies Virus Pathogenesis
Requires several weeks for infection to become apparent
Transmission through bite or scratch from infected animal
Replication in muscle and connective tissues at site of inoculation
Enters peripheral nervous system at neuromuscular junctions
Spreads up the peripheral nerves to the central nervous system
Encephalitis
Virus grows to high titers in the salivary glands
Rabies patients must be restrained
Negri bodies appear in neuron cell bodies
Clinical spectrum
Prodrome - nausea, headaches, fever, sore throat, photophobia
Acute neurologic phase - apprehension, nervousness, hallucinations, behavioral anomalies, salivation, perspiration, hydrophobia, photophobia
Coma - seizures and death (99+%)
Negri bodies

6. Rabies Virus One survival using novel medical treatment
NEJM :
15 year old Jeanna Giese bitten by a bat
Presented with clinical rabies after one month
Treatment
Induced coma
Administered high doses of ketamine to suppress brain activity
Required mechanical ventilation
Administered heparin
Administered ribavirin, an antiviral, to protect the heart from rabies-induced cardiomyopathy
Days 8-10 showed improvement in cardiovascular and neurological functions
By day 23 she could sit up in bed, but neurological manifestations persisted
Required prolonged physical therapy, but is continuing to recover
This treatment failed for a Texas boy

7. Rabies Virus Laboratory diagnosis PCR Serology (IFA) Animal control
Rabid or suspected rabid animals are killed and examined by histopathology for Negri bodies and viral antigen
Vaccination of pets is required by law in most states
Immunity and protection
Vaccines
First one developed by Pasteur by using spinal cords from infected dogs
Today’s principal vaccine is the human diploid cell vaccine (HDCV) made in the WI-38 fibroblast cell line
Virus is inactivated by βPL
Post-exposure prophylaxis
One dose of hyperimmune antiserum
Five immunizations over 28 days

8. Rabies Virus Epidemiology Enzootic in wild and domesticated animals
In the U.S., edible vaccines are dispersed to control wild animal rabies
More than 200 people die from rabies in China each month
Reservoirs might be bats
But the slow-growing nature of rabies virus also contributes to its persistence in nature

9. Prion Diseases Proteinacious infectious agents
Diseases are transmissible spongiform encephalopathies (TSEs)
There are also inherited spongiform encephalopathies
Human
Creutzfeldt-Jakob Disease - sporatic
New Variant CJD - from beef (“mad cow disease”)
Kuru - ritualistic cannibalism (consuming brains of infected dead)
Fatal familial insomnia
Animal
Bovine spongiform encephalopathy (“mad cow” disease)
Scrapie - sheep
Chronic wasting disease - deer, elk, moose

10. Prion Diseases Pathogenesis Poorly understood
The prion protein is a normal cellular protein, encoded by the PRPC gene
The gene is found on the short arm of chromosome 20
It is thought to be involved in ion transport
It is prominently expressed in the CNS
Some mutant alleles occur in familial enecphalopathies
Protein folding
The properly-folded protein is termed PrPc
The misfolded protein is termed PrPSc
It is unknown why the protein misfolds
However, once misfolded, it can cause misfolding of other copies of PrPc
The misfolded protein is highly resistant to heat and protease digestion
TSEs have been transmitted by autoclaved surgical instruments
The misfolded proteins apparently elude the ubiquitin/proteosome system
Cells export the misfolded protein, which then forms extracellular plaques
These plaques interfere with neuronal communication
Normal Misfolded