Crack the Case: Seizures, Fever, and a Fatal Outcome

Neuropathology for Neurologists

James W. Mandell, MD, PhD

Disclosures

September 09, 2013

So Was It The Trip to the Dentist?

Viral replication leads to accumulation of intracellular virions or unassembled viral components in the cytoplasm or nucleus of the cell and sometimes forms visible inclusions. (To view an electron micrograph of a Negri body and associated budding rabies virions, click here.)

Distinctive infectious viruses produce characteristic inclusions, such as Guarnieri bodies in the cytoplasm of poxvirus infected cells, Councilman bodies in viral hepatitis, and intranuclear Cowdry bodies in herpesvirus infected cells. These eponymous inclusions continue to confuse and annoy generations of medical students.

Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected mammal. The most common mode of rabies virus transmission is through a bite and virus-containing saliva of an infected host animal, typically raccoon, skunk, fox, coyote and several species of insectivorous bats. Much more rarely, as in this case, there is no known history of animal bite or saliva contact, and it is very unlikely that the patient's dental procedure was the transmitting event.[3,4]

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