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Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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I am looking forward to hearing from you.

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David Rain
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

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David Rain
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A Case Report: Radiologic Findings of Central Nervous System and Pulmonary System Involvement of Rabies Infection

Bayramov Rasim, Gasimova Naila*, Huseynova Sayyara

Azerbaijan State Advanced Training Institute for Doctors named after A.Aliyev, Baku, Azerbaijan

Abstract: Rabies is neurotropic viral infection involving the central nervous system. It results rapid neurological deterioration and almost progress to the death. Rabies infection may be manifest extraneural involvement in various systems. In this case report we aim to give a review of rabies infection and report radiologic findings of this condition. We report a case of 18-year-old male biten by a dog 20 days ago who presented altered mental status, irritability, hypersalivation and agitation. The diagnosis of rabies was made based on exposure history, typical clinical symptoms and radiologic findings. Rabies diagnosis is essentially clinical. Brain MRI was used to differentiate it from other encephalitis.

Keywords: Rabies, encephalitis, pneumonia, MRI, CT

Received July 03, 2024; Revised August 04, 2024; Accepted August 11, 2024

Citation: Bayramov Rasim, Gasimova Naila, Huseynova Sayyara, A Case Report: Radiologic Findings of Central Nervous System and Pulmonary System Involvement of Rabies Infection. American Journal of Medical Case Reports, 12 (8). 117-120. January 2024. doi:10.12691/ajmcr-12-8-3

1. Introduction

Rabies is acute, rapidly progressing encephalomiyelitis caused by the virus Rhabdoviridae family, Lyssavirus genus [1]. It is most frequently transmitted to humans via biting, scratching or licking of infected animals usually a dog in developing countries and bat in developed countries [2]. Human-to-human transmission is very rare [3]. While rabies is a significant public health problem in developing countries, the disease is preventable with proper vaccination and post-exposure prophylaxis. The World Health Organization estimates that rabies kills 35,000- 55,000 people each year [4]. Typically incubation period is around 2 weeks to 2 months [5]. Prodromal symptoms include fever, malaise and tingling at the site of exposure. Initially the virus is present at the wound site. Then the virus reaches central nervous system along the peripheral nerves. After the encephalitis the virus spread other organs along peripheral nerves [6]. Central nervous symptoms may be paralitic or encephalitic form. Also there may be extraneural involvement such as pulmonary sistem in our case. Bilateral pneumonia is rare extraneural manifestation in rabies infection. This condition is often associated with a poor prognosis and high mortality rate.

2. Case Presentation

A previously healthy 18-year-old male patient presented to the emergency department with a history of being bitten by a dog 20 days prior to admission. Initially, he was treated conservatively for the dog bite wound and was discharged. However, he began to experience worsening neurological symptoms, leading to hospitalization.

Upon admission, the patient was found to have bilateral basal ganglia hyperdensity on computed tomography (CT) scans, suggesting overhydration (Figure 1). Magnetic Resonance Imaging (MRI) revealed pathological signal changes in the basal ganglia, consistent with a possible autoimmune response to the dog bite (Figure 2 Figure 3 Figure 4 Figure 5). The patient was treated with corticosteroids and immunosuppressive therapy.

Figure 1. Bilateral basal ganglia hyperdensity on computed tomography (CT) scans

Figure 2. Axial T2 MRI series show hyperintensities in bilateral basal ganglia

Figure 3. Axial T2 MRI series show hyperintensity in dorsal pons

Despite initial improvement, the patient's condition deteriorated rapidly, and he became increasingly lethargic and short of breath. A repeat CT scan of the lungs revealed bilateral pneumonia (Figure 6 Figure 7 Figure 8 Figure 9 Figure 10). The patient's condition continued to deteriorate, and he ultimately succumbed to his illness.

Figure 4. Axial FLAIR MRI series show hyperintensity in dorsal pons

Figure 5. Axial FLAIR MRI series show hyperintensities in bilateral basal ganglia

Figure 6. On axial CT examination there was pneumonic consolidation and infiltration dominantly in lower lobe

Figure 7. On axial CT examination there was pneumonic consolidation and infiltration dominantly in lower lobe

Figure 8. On coronal CT examination there was pneumonic consolidation and infiltration dominantly in lower lobe

Figure 9. On coronal CT examination there was pneumonic consolidation and infiltration dominantly in lower lobe

Figure 10. On coronal CT examination there was pneumonic consolidation and infiltration dominantly in lower lobe

This case report highlights the potential for severe and fatal complications following dog bites, even in previously healthy individuals. The diagnosis and management of such cases require a high index of suspicion and a multidisciplinary approach. Further research is necessary to better understand the underlying mechanisms and to develop effective treatments for this condition.

3. Discussion

Diagnosis is usually made on typical clinical presentations. The diasease progress in 3 phases: prodromal phase, neurologic phase, coma and death. In the prodromal phase there is paresthesia and pain at the wound site, fever, headache, vomiting and irritability. In humans, rabies encephalitis presents in two clinical forms. The first form, classic rabies encephalitis characterized by altered mental status, generalized malaise, inspiratory spasms and autonomic dysfunction is follwed by hypersalivation, hydrophobia and aerophobia [7]. The second form, paralitic rabies is characterized by quadriparesis and bilateral facial weakness [8]. Most routine laboratory examinations are normal or non-spesific. Cerebrospinal fluid examination may be normal, or slight increase in lymphocytes and protein levels may be. Specific anti-rabies antibodies in the CSF may be positive, indicating rabies encephalitis [9]. PCR can detect viral RNA in the saliva, CSF, urine, skin, and brain tissues [9]. Owing to characteristic clinical presentation imaging studies are rarely performed [10]. But MRI is the most sensitive modality for rabies encephalitis. In rabies encephalitis, brain MRI may show increased T2A/FLAIR signal intensity in gray matter of brain parenchyma; basal ganglia, tahalami, hypothalami, brainstem, limbic system, frontal and parietal lobes. Moderate postcontrast enhancement may be seen in this localizations. In the paralytic form of rabies, involvement of spinal cord and medulla are prominent [11,12,13].

Differential diagnosis of rabies encephalitis from an imaging is acute disseminated encephalomiyelitis (ADEM), other viral encephalitis, ischemic encephalitis, rhomboencephalitis and Guillain-Barre syndrome [9,14]. ADEM is an important differential diagnosis of paralytic rabies. In rabies encephalitis MRI findings are symmetrical and dominantly involved deep gray matter structures, in ADEM there is asymmetrical involvement of white matter structures of brain and spinal cord [9,11]. Gray matter involvement, the absence of hemorrhages, and the absence of enhancement during the acute phase of the disease help differentiate rabies encephalitis from Japanese B and other viral encephalitis like herpes simplex encephalitis which usually involve mesial temporal lobes and insular cortex [7,9,10,12] . DWI may be useful to differentiate rabies encephalitis from ischemic encephalitis and mitochondrial diasease, because of rabies encephalitis does not show obvious restriction [9,11]. A typical history of animal bite end rapid progression of the diasease differentiates rabies encephalitis from Guillain-Barre syndrome [9,12]. There is no effective treatment for rabies encephalitis, the management of these patients is palliative and supportive. Typical therapeutic attempts, which if instituted early have in some instances resulted in survival include human rabies immunoglobulin infusion, rabies vaccine, ribavirin, interferon alfa, and ketamine [12].

Also extraneural involvement has been frequently documented in salivary glands and skin, cardiac, pulmonary, hepatic and renal impairment have been described in small proportion of this patients [15]. The pathophysiogy of bilateral pneumonia in rabies not fully understood. It may be related the spread of rabies virus to the lungs, aspiration due to pharyngeal muscle spasms and involvement of respiratory control centers of brain.

The clinical features of pneumonia in rabies encephalitis are non-spesific, include fever, cough and shortness of breath. In severe cases, respiratory failure requiring mechanical ventilation may develop. Laboratory tests, such as chest X-rays and computed tomography can help confirm the diagnosis. In CT examination there is consolidation and pneumonic infiltrations in both lungs. The management of pneumonia primarily supportive, with focus on managing respiratory failure and controlling the symptoms.

4. Conclusion

Rabies presents acute atypical presentation of encephalitis and acute flaccid paralisis. It is rapidly fatal because lack of any curative treatment. It is definitively confirmed by the isolation of the virus from biological samples such as saliva, CSF, hair, or detection of rabies antigens or antibodies.There may be extraneural manifestation of rabies also which spreads various organs along peripheral nerves. Postexposure rabies prophylaxis should be administered immediately after exposure using proper technique according to WHO guidelines to reduce therapy failure.

Conflict of Interest

The authors state that there is no conflict interest.

ACKNOWLEDGEMENTS

The consent form was filled out by the patient.

Abbreviations

MRI- Magnetic Resonance Imaging

CT- Computed Tomography

References

[1]   | Smith SP, Wu G, Fooks AR, Ma J, Banyard AC. Trying to treat the untreatable: experimental approaches to clear rabies virus infection from the CNS. J Gen Virol. 2019; 100(8): 1171- 1186.
[2]   | Mindekem R, Lechenne M, Doumagoum Daugla M, Zinsstag J, Ouedraogo LT, Salifou S. Rabies knowledge, attitudes, and practices of human and animal healthcare providers in Chad. Sante Publique. 2018; 30(3): 418- 428.
[3]   | SC Chaudhary, A Khandelwal, R Tandon, KK. Sawlani: Rabies encephalitis BMJ Case Rep, 14 (4) (2021), Article e239249, 10.1136/bcr-2020-239249.
[4]   | AR Fooks, AC Banyard, DL Horton, N Johnson, LM McElhinney, AC. Jackson;Current status of rabies and prospects for elimination; Lancet, 384 (9951) (2014), pp. 1389-1399, 10.1016/S0140-6736(13)62707-5; Epub May 11, 2014.
[5]   | Awasthi M, Parmar H, Patankar T et-al. Imaging findings in rabies encephalitis. AJNR Am J Neuroradiol. 2001; 22 (4): 677-80. AJNR Am J Neuroradiol (full text) - Pubmed citation.
[6]   | JL Jameson, AS Fauci, DL Kasper, SL Hauser, DL Longo, J Loscalzo ; Harrison’s principles of internal medicine; eds (20th ed.), McGraw-Hill Education, New York (2018).
[7]   | Laothamatas J, Hemachudha T, Mitrabhakdi E, Wannakrairot P, Tulayadaechanont S. MR imaging in human rabies. AJNR Am J Neuroradiol. 2003; 24(6): 1102- 1109. https:// www.ajnr.org/ content/24/6/1102.
[8]   | Tirawatnpong S, Hemachudha T, Manutsathit S, Shuangshoti S, Phanthumchinda K, Phanuphak P. Regional distribution of rabies viral antigen in central nervous system of human encephalitic and paralytic rabies. J Neurol Sci. 1989; 92(1): 91-99.
[9]   | Magnetic resonance imaging in rabies encephalitis, a case report, and review of the literature; Abasin Tajmalzai MD, MPH, PGD, Ataullah Zarabi MD, MPH, PGD.
[10]   | Rao AS, Varma DR, Chalapathi Rao MV, Mohandas S. Case report: Magnetic resonance imaging in rabies encephalitis. Indian J Radiol Imaging. 2009; 19: 301–4.
[11]   | J Mani, BC Reddy, R Borgohain, S Sitajayalakshmi, C Sundaram, S. Mohandas;Magnetic resonance imaging in rabies; Postgrad Med J, 79 (932) (2003), pp. 352-354, 10.1136/pmj.79.932.352.
[12]   | SJ Co, IR Mackenzie, JR. Shewchuk; Rabies encephalitis, Radiographics, 35 (1) (2015), pp. 235-238, 10.1148/rg.351140035.
[13]   | M Awasthi, H Parmar, T Patankar, M. Castillo;Imaging findings in rabies encephalitis; AJNR Am J Neuroradiol, 22 (4) (2001), pp. 677-680.

[14]  
Mindekem, M Lechenne, M DoumagoumDaugla, J Zinsstag, LT Ouedraogo, S Salifou; Connaissances-Attitudes-Pratiques des agents de santé humaine et animale sur la rage au Tchad [Rabies knowledge, attitudes, and practices of human and animal healthcare providers in Chad] ; Sante Publique, 30 (3) (2018), pp. 418-428, 10.3917/spub.183.0418.

[15]   | Rabies encephalitis and extra-neural manifestations in a patient bitten by a domestic cat. Silvia Soler-Rangel, 1 Natalie Jiménez-Restrepo, 2 Daniel Nariño, 1 and Diego Rosselli 3.