RABIES ENCEPHALITIS IN A PATIENT WITH AIDS - A CLINICOPATHOLOGICAL STUDY

A 46-year-old man was bitten by a dog in Mall; anti-rabies vaccination was incomplete. Three months later he was admitted to hospital with f ever and diarrhea. Human immunodeficiency virus (HIV) serology was pos itive and CD4 count was 70/mm(3). His status worsened rapidly with con fusion hydrophobia and hypersialorrhea. Despite anti-rabies serotherap y and vaccination, he died suddenly 12 days after admission. Immunoflu orescence on cerebral tissue samples established rabies encephalitis. Neuropathology showed mild encephalitis with occasional Babes nodules and rare perivascular mononuclear cuffs, Intraneuronal Negri inclusion bodies were remarkably diffuse and abundant. They were clearly demons trated by immunocytochemistry and electron microscopy, Apoptotic neuro ns were identified in the brain stem and hippocampus in the vicinity o f inflammatory foci, In contrast, apoptosis could not be demonstrated in non-inflammatory areas, even where Negri bodies were numerous. Ther e was no associated HIV encephalitis or opportunistic infection, The o ccurrence of rabies encephalitis in AIDS represents a random associati on, but is probably not exceptional as rabies is endemic in many count ries and the AIDS epidemic is spreading worldwide, In this case, altho ugh the incubation duration and clinical presentation were comparable to those in classical rabies, the T-cell-mediated immunosuppression ma y account for the weak inflammatory reaction and unusually abundant vi ral multiplication, This observation confirms that all those at risk f or rabies, particularly immunocompromised patients, should receive com plete anti-rabies treatment including vaccines and specific immunoglob ulins, as soon as possible after infection.