Lyssa (Rabies): Symptoms, Causes and Treatment
Lyssa (rabies) is a life-threatening viral disease transmitted through the bite of infected animals, affecting the central nervous system.
Things worth knowing about "Lyssa"
Lyssa (rabies) is a life-threatening viral disease transmitted through the bite of infected animals, affecting the central nervous system.
What is Lyssa?
Lyssa, commonly known as rabies, is a severe infectious disease caused by the rabies virus (a Lyssavirus belonging to the family Rhabdoviridae). The virus attacks the central nervous system and is almost always fatal once clinical symptoms appear. Rabies is classified as a zoonosis – a disease that can be transmitted from animals to humans – and remains one of the most dangerous infectious diseases worldwide.
Causes and Transmission
The Lyssavirus is primarily transmitted through the saliva of infected animals, most commonly via:
- Bite wounds from infected animals (e.g., dogs, foxes, bats, raccoons)
- Contact of infected saliva with open wounds or mucous membranes
- Rarely, scratches from infected animals
Globally, dogs are the most common source of rabies transmission to humans, particularly in Asia and Africa. In Europe and North America, bats have become an increasingly important viral reservoir.
Symptoms
The incubation period is typically 1 to 3 months, but can range from a few days to several years depending on the location of the bite and the amount of virus introduced.
Early Phase (Prodromal Phase)
- Fever, headache, and general malaise
- Tingling, pain, or numbness at the site of the bite
- Anxiety, restlessness, and sleep disturbances
Acute Neurological Phase
- Hydrophobia (fear of water – painful spasms when attempting to swallow liquids)
- Aerophobia (fear of drafts or air movement)
- Hallucinations, confusion, and aggressive behavior
- Muscle spasms and paralysis
- Coma and respiratory failure in the terminal stage
Diagnosis
Diagnosing rabies is clinically challenging, particularly in the early stages when symptoms are non-specific. The following diagnostic methods are used:
- PCR testing (polymerase chain reaction) from saliva, cerebrospinal fluid, or skin biopsy
- Antibody detection in blood or cerebrospinal fluid
- Direct fluorescent antibody test (dFA) on brain tissue (mostly post-mortem)
- Clinical assessment based on possible animal exposure history
Treatment
Post-Exposure Prophylaxis (PEP)
The most critical step following a suspected bite is immediate wound care and initiation of post-exposure prophylaxis (PEP), which includes:
- Thorough wound washing with soap and water
- Vaccination with an inactivated rabies vaccine (multiple doses over several weeks)
- For previously unvaccinated individuals: administration of rabies immunoglobulin directly into and around the wound
When PEP is administered promptly after exposure, it can almost completely prevent the onset of the disease.
Treatment of Manifest Disease
Once clinical symptoms have developed, there is no proven curative therapy. Treatment is primarily supportive and intensive care-based. The so-called Milwaukee Protocol (medically induced coma) has been attempted in isolated cases, with very rare survivors reported.
Prevention
- Pre-exposure prophylaxis (PrEP): Vaccination recommended for high-risk groups (veterinarians, travelers to endemic regions, laboratory staff)
- Avoiding contact with wild or unknown animals
- Vaccination of domestic animals, especially dogs and cats
- Prompt medical attention after any animal bite
Epidemiology
According to the World Health Organization (WHO), an estimated 59,000 people die from rabies each year worldwide, with the majority of deaths occurring in Asia and Africa. In Germany, rabies in terrestrial mammals has been declared eradicated since 2008; however, a residual risk remains through bats and travel to endemic regions.
References
- World Health Organization (WHO): Rabies – Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/rabies
- Robert Koch Institute (RKI): Tollwut – RKI Advisory. Available at: https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Tollwut.html
- Hemachudha T, Ugolini G, Wacharapluesadee S et al.: Human rabies: neuropathogenesis, diagnosis, and management. The Lancet Neurology. 2013;12(5):498–513.
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