Epidemology and clinical aspects of human rabies in Minas Gerais, Brasil: misdiagnosis and misunderstandings on the psychopathological disturbances

Neves, Jayme; Carvalho, Antônio Cândido de Melo; Velloso, Sylvio Megre

doi:10.1590/S0037-86821980000100008

Abstracts

This paper reports 40 cases of human rabies studied at the Carlos Chagas Hospital of UFMC, State of Minas Gerais, Brazil, from 1963 through 1976. From the epidemioiogical point of view it is concluded that the magnitude of the problem of human rabies in underdeveioped countries remains quite unknown. Speciai emphasis is given to the lack of apropriate knowledge of the recommended preventive measures, and to the influence of health education and socio-economic-cultural structure of the communities. The classic clinical picture of human rabies is briefiy described, particular attention being drawn to psychopathologic features of rabies encephalomyeiitis. it is pointed out that in some cases the mental symptoms may predominate from the onset of the illness, adding difficuity to the diagnosis. According to the Authors, human rabies must be differentiated from several psychopathologic syndromes and also from encephalomyelitis due to other central nervous system infections. It is discussed whether the fataiistic concept of human rabies would be somehow contributing to delay a better understanding of the natural history of the disease.

No trabalho são estudados 40 casos de raiva humana identificados no Hospital Carlos Chagas da UFMG, Minas Gerais, Brasil, durante o período compreendido entre 1963 e 1976. Do ponto de vista epidemiológico, concluiu-se que a magnitude do problema gerado pela raiva nos países em desenvolvimento permanece ainda desconhecida. Neste particular, merecem realce o inadequado conhecimento das medidas preventivas recomendadas e a influência de fatores dependentes da educação sanitária e das estruturas sócio-econômica e cultural das comunidades. Descreveu-se sumariamente o quadro clínico clássico da encefalomielite rábica, ressaltando-se suas peculiaridades psicopatológicas. Salientou-se que, em alguns casos, a sintomatologia mental pode predominar desde o início da doença, acarretando dificuldades ao diagnóstico. Segundo os Autores, a raiva humana deve ser diferenciada de diversas síndromes psicopatológicas, bem como de encefalomielites devidas a outras infecções do sistema nervoso central. Finalmente, questiona-se, baseado na casuística apresentada, se o conceito fatalístico da raiva humana não estará contribuindo de algum modo para retardar um melhor conhecimento da história natural da doença.

Epidemology and clinical aspects of human rabies in Minas Gerais, Brasil: misdiagnosis and misunderstandings on the psychopathological disturbances

Jayme Neves^I; Antônio Cândido de Melo Carvalho^II; Sylvio Megre Velloso^III

^IProfessor Titular da Clínica das Doenças Infectuosas e Parasitárias

^IIProfessor Assistente

^IIIPsiquiatra da Secretaria de Estado da Saúde

ABSTRACT

This paper reports 40 cases of human rabies studied at the Carlos Chagas Hospital of UFMC, State of Minas Gerais, Brazil, from 1963 through 1976. From the epidemioiogical point of view it is concluded that the magnitude of the problem of human rabies in underdeveioped countries remains quite unknown. Speciai emphasis is given to the lack of apropriate knowledge of the recommended preventive measures, and to the influence of health education and socio-economic-cultural structure of the communities. The classic clinical picture of human rabies is briefiy described, particular attention being drawn to psychopathologic features of rabies encephalomyeiitis. it is pointed out that in some cases the mental symptoms may predominate from the onset of the illness, adding difficuity to the diagnosis. According to the Authors, human rabies must be differentiated from several psychopathologic syndromes and also from encephalomyelitis due to other central nervous system infections. It is discussed whether the fataiistic concept of human rabies would be somehow contributing to delay a better understanding of the natural history of the disease.

RESUMO

No trabalho são estudados 40 casos de raiva humana identificados no Hospital Carlos Chagas da UFMG, Minas Gerais, Brasil, durante o período compreendido entre 1963 e 1976. Do ponto de vista epidemiológico, concluiu-se que a magnitude do problema gerado pela raiva nos países em desenvolvimento permanece ainda desconhecida. Neste particular, merecem realce o inadequado conhecimento das medidas preventivas recomendadas e a influência de fatores dependentes da educação sanitária e das estruturas sócio-econômica e cultural das comunidades. Descreveu-se sumariamente o quadro clínico clássico da encefalomielite rábica, ressaltando-se suas peculiaridades psicopatológicas. Salientou-se que, em alguns casos, a sintomatologia mental pode predominar desde o início da doença, acarretando dificuldades ao diagnóstico. Segundo os Autores, a raiva humana deve ser diferenciada de diversas síndromes psicopatológicas, bem como de encefalomielites devidas a outras infecções do sistema nervoso central. Finalmente, questiona-se, baseado na casuística apresentada, se o conceito fatalístico da raiva humana não estará contribuindo de algum modo para retardar um melhor conhecimento da história natural da doença.

Full text available only in PDF format.

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Recebido para publicação em 28.2.78.

Trabalho da Clinica das Doenças Infectuosas e Parasitárias da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.

Esta pesquisa foi parcialmente financiada pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

1. ANDRAL, L. & SÉRIÉ, C.: Études expérimentales sur la rage en Ethiopie. Ann. Inst. Pasteur (Paris) 93: 475- 488,1957.
2. ANDRAL, L. & SÉRIÉ, C.: Études experimentales sur la rage en Ethiopie. IV. Inféccion rabique latente. Porteur assyntomatique ou porteur silencieuse. Ann. Inst. Pasteur (Paris) 108:442-451, 1965.
3. BELL, J. F.: Abortive rabies infection. I. Experimental production in white mice and general discussion. J. Inf. Dis. 114: 249-257, 1964.
4. BELL, J. F.: Abortive rabies. International Symposium on rabies. Intern. Ass. of Microbiology Societies. Talloires. Lac D'annecy France, 1965.
5. BELL, J. F.: Chronic rabies infection. Proc. Nat. Rabies Symposium, NCDC, Atlanta, Geórgia, USA pp 17- 21, 1966.
6. Boletim Epidemiológico Ministério da Saúde Situação da Raiva no Brasil. Nos 5-6, 1972.
7. BOLIN, V. S.: Survival of a guinas pig following infection with Street ravies virus: a case report. J. Am. Vet. Med. Assoc. 134 : 90-92, 1959.
8. BROZ, O. & PHAN TRINH: Contribution au problème du chien "porteursain" de virus rabique. J. Hyg. Epid. (Praha) 6: 73-78, 1961.
9. Center for Disease Control - Human rabies Califórnia. Morbid Mortal Weekly Rep. 20:135-142, 1971.
¹⁰
CAVEAU (in Remlinger, 1907).
11. DAUNOY, R.: Spontaneous recovery of rabbit from experimental rabies. J. Inf. Dis. 34:425-427, 1924.
12. D'SILVA, C. B.: Studies on rabies. VIII. Observations on recovery from rabies, prolonged illness in rabies and neurosterilization. Indian J. Med. Res. (Calcutá) 40: 317-325, 1952.
13. FORST, J.: Beitrag zur kenntnis atupischer und abortiver Lyssaformer bei Hunden. Klin. Spisv. Vys. Sk. Zverolek, Brunn. Tchecols. 1: 10-1924 (in Trop. Dis. Bull. 21: 708-714, 1924).
14. HALASZ, E.: Un cas de rage guerie chez un bovin (in Réc. Méd. Vet. 111: 286, 1935).
15. HATTWICK, M. A. W.; WEIS, T. T.; STECHSCHULTE, J.; BAER, G. M., GREG, M. B.: Recovery from rabies. A case report. Ann. Int. Med. 76: 961-942, 1972.
16. HELD, J. R.; TIERKEL, E. S. & STEELE, J. H.: Rabies in man and animais in the United States, 1946- 1965. Public Health Rep. 82: 1009- 1018, 1967.
17. JOHnãoN, H. N.: Rabies, in Viral and Rickettsial Infections of Man. Revers, T. J. B., Lippincott co., Philadelphia, 1959.
18. JOHnãoN, H. N.: Sporadic cases of rabies in wildlife: relation to rabies in domestic animais and character of virus. Proc. Nat. Rabies Symposium, NCDC, Atlanta, Geórgia, USA, pp 25-30, 1966.
19. KANTOROVICH, R. A.; DONOVALOV, G. V.; BUZINOV, I. A. & RIUTOVA, V. P.: Experimental investigations into rage and rabies in polar foxes. Study of rage in polar foxes. Acta Vi rol. (Praha) 7: 554-560, 1963.
20. KITSELMAN, C. G.: Recovery of a rat from experimentally induced rabies. J. Am. Vet. Med. Assoc. 144: 1113- 1114,1964.
21. KRAU3, R.; GERLACH, F. & SCHWEINBURG, F.: Lyssa bei Mensch und Tier. Berlin, Urban und Schwarzenberg, pp 148-166, 1926.
22. KUBES, V. & GALLIS, F.: La cerebroneutralización, nueva reacción biologica para el virus rabico. Su relación com la prueba de protección y la sero-neutralización. Bol. Inst. Invest. Vet. 1:103-150,1943.
23. LIEOU, Y. C.: Carriers of rabies virus. Chin. Med. J. 66:694-699, 1948.
24. LÓPEZ, M.; NEVES, J.; MOREIRA, E.C.; REIS, R.; TAFURI, W. L.; PITTELA R. E.; MARINHO, R. P.; MARRA, U. D.; ALVARES, J. M.; DINIZ, I.; SILVA, O. S.; FOSCARINI, L. F.; CAMPOS, G. B.; MARTINS, M. T.; TOFANI, M. T.: Human rabies. I. Intensive treatment. Rev. Inst. Med. trop. São Paulo 17:103-110,1975.
25. MARTIN, L. A.: Infection rabique et rage curable. Maroc. Med. (Casablanca) 42AG1A13, 1963.
26. NEVES, J.: Raiva humana: Estudo clínico e atualização da profilaxia. Rev. Assoc. Méd. Minas Gerais 21: 13-22, 1970.
27. NILSSON, M. R.: Revisão do conceito de que a raiva é sempre fatal. Bol. Ofic. Sanit. Panamericana 68: 486-494, 1970.
28. OFFEMBERG, W.: Cas de rage guéri chez l'home. Rec. Med. Vet. 61: 559-566, 1884.
29. PAWAN, J. L.: The transmission of paralytic rabies in Trinidad by the vampire bat. Ann. Trop. Med. Parasit. 30: 101-130, 1936.
30. PÉREZ-GONZALEZ: In Martin, L. A., Infection rabique et rage curable. Marc. Med. (Casablanca) 42: 467, 1963.
31. PHILIPS, J. M.; BERRY, F. & SNOOK, J. H.: Recovery of animais apparently rabid. J. Infect. Dis. 29: 96-108, 1921.
32. REIS, R.; MOREIRA, E. C.; NEVES, J.; LÓPEZ, M.; TAFURI, W. L.; PITTELA, J. E.; MARINHO, R. P.; MARRA, U. D.; ALVARES, J. M.; DINIZ, I.; SILVA, O. R.; FOSCARINI, L.G.; MARTINS, M. T. & TOFANI, M. G.: Human rabies. II. Serological studies and intravitam virus isolation. Rev. Inst. Med. trop. São Paulo 18: 393- 401, 1976.
33. RELOVA, R. N.: Hydrophobia: its prevention and cure. S. Tomáz J. Med. 11: 259-270, 1956.
34. REMLINGER, P.: La guérison spontanée de la rage experimentale du chien et la persistance du virus rabique dans la salivedes animaus guéris. Ftéc. Méd. Vét. 84: 269-280, 1907.
35. RUBIN, R. H.; SULLIVAN, L. & SUMMERS, R.: A case of human rabies in Kansas: epidemiologic, clinical, and laboratorial consideration. J. Infect. Dis. 122 : 318-322. 1970.
36. SCHOENING, H. W.: Rabies. Proc. Sixth Pacific Science Congress (San Francisco, University of Califórnia) 5: 191-196, 1969.
37. SCHNEIDER' L. G. & SCHOOP, U.: Pathogenesis of rabies and rabies-like viruses. Ann. inst. Pasteur (Paris) 723:469-476, 1972.
38. SIKES, R. K.: Guidelines for the control of rabies. Am. J. Pub. Hith. 60: 1133-1138, 1970.
39. STARR, L.; SELLERS, T. E. & SUNKES, E. J.: Apparent recovery of a dog from rabies. JAMA 121: 296, 1973.
40. STEELE, J. H.: The epidemiology and control of rabies. Scand. J. Infect. Dis. 5: 299-312, 1973.
41. THIÉRY, J.: Un chien d'apparence saine peut-il transmettre la rage? Rev. Gen. Med. Vet. 58:451-460, 1929.
42. VEERARAGHAVAN, N.; GAJANANA, A. & R A IMG ASA Ml, R.: Hydrophobia among persons bitten by apparently healthy animais. The Pasteur Institute of Southern India. Coonoor, Sci. Rep. 19: 90-91,1967.
43. VEERARAGHAVAN, N.: Hydrophobia among persons bitten by apparently Healthy animais. The Pasteur Institute of Southern India. Coonoor Sci. Rep. 19:71,1968.
44. VELLA, E. C.: Correspondence. Lancet 5: 277, 1972.
45. WEBSTER, L. T.: A mouse test for measuring the immunizing potency of antirabies vaccines. J. Exp. Med. 70: 87-106,1939.
46. WEBSTER, L. T.: Rabies. McMillan Co., New York, 1942.
47. YOURKOVSKY, A. M.: Hydrophobia following the bite of apparently healthy dogs. J. Hyg. Epidm. (Praha) 6: 73-78,1962.

Publication Dates

Publication in this collection
10 June 2013
Date of issue
Dec 1980

History

Received
28 Feb 1978
Accepted
28 Feb 1978

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ANDRAL, L. & SÉRIÉ, C.: Études expérimentales sur la rage en Ethiopie. Ann. Inst. Pasteur (Paris) 93: 475- 488,1957.

[2] 2. ANDRAL, L. & SÉRIÉ, C.: Études experimentales sur la rage en Ethiopie. IV. Inféccion rabique latente. Porteur assyntomatique ou porteur silencieuse. Ann. Inst. Pasteur (Paris) 108:442-451, 1965.

[3] 3. BELL, J. F.: Abortive rabies infection. I. Experimental production in white mice and general discussion. J. Inf. Dis. 114: 249-257, 1964.

[4] 4. BELL, J. F.: Abortive rabies. International Symposium on rabies. Intern. Ass. of Microbiology Societies. Talloires. Lac D'annecy France, 1965.

[5] 5. BELL, J. F.: Chronic rabies infection. Proc. Nat. Rabies Symposium, NCDC, Atlanta, Geórgia, USA pp 17- 21, 1966.

[6] 6. Boletim Epidemiológico Ministério da Saúde Situação da Raiva no Brasil. Nos 5-6, 1972.

[7] 7. BOLIN, V. S.: Survival of a guinas pig following infection with Street ravies virus: a case report. J. Am. Vet. Med. Assoc. 134 : 90-92, 1959.

[8] 8. BROZ, O. & PHAN TRINH: Contribution au problème du chien "porteursain" de virus rabique. J. Hyg. Epid. (Praha) 6: 73-78, 1961.

[9] 9. Center for Disease Control - Human rabies Califórnia. Morbid Mortal Weekly Rep. 20:135-142, 1971.

[10] ¹⁰
CAVEAU (in Remlinger, 1907).

[11] 11. DAUNOY, R.: Spontaneous recovery of rabbit from experimental rabies. J. Inf. Dis. 34:425-427, 1924.

[12] 12. D'SILVA, C. B.: Studies on rabies. VIII. Observations on recovery from rabies, prolonged illness in rabies and neurosterilization. Indian J. Med. Res. (Calcutá) 40: 317-325, 1952.

[13] 13. FORST, J.: Beitrag zur kenntnis atupischer und abortiver Lyssaformer bei Hunden. Klin. Spisv. Vys. Sk. Zverolek, Brunn. Tchecols. 1: 10-1924 (in Trop. Dis. Bull. 21: 708-714, 1924).

[14] 14. HALASZ, E.: Un cas de rage guerie chez un bovin (in Réc. Méd. Vet. 111: 286, 1935).

[15] 15. HATTWICK, M. A. W.; WEIS, T. T.; STECHSCHULTE, J.; BAER, G. M., GREG, M. B.: Recovery from rabies. A case report. Ann. Int. Med. 76: 961-942, 1972.

[16] 16. HELD, J. R.; TIERKEL, E. S. & STEELE, J. H.: Rabies in man and animais in the United States, 1946- 1965. Public Health Rep. 82: 1009- 1018, 1967.

[17] 17. JOHnãoN, H. N.: Rabies, in Viral and Rickettsial Infections of Man. Revers, T. J. B., Lippincott co., Philadelphia, 1959.

[18] 18. JOHnãoN, H. N.: Sporadic cases of rabies in wildlife: relation to rabies in domestic animais and character of virus. Proc. Nat. Rabies Symposium, NCDC, Atlanta, Geórgia, USA, pp 25-30, 1966.

[19] 19. KANTOROVICH, R. A.; DONOVALOV, G. V.; BUZINOV, I. A. & RIUTOVA, V. P.: Experimental investigations into rage and rabies in polar foxes. Study of rage in polar foxes. Acta Vi rol. (Praha) 7: 554-560, 1963.

[20] 20. KITSELMAN, C. G.: Recovery of a rat from experimentally induced rabies. J. Am. Vet. Med. Assoc. 144: 1113- 1114,1964.

[21] 21. KRAU3, R.; GERLACH, F. & SCHWEINBURG, F.: Lyssa bei Mensch und Tier. Berlin, Urban und Schwarzenberg, pp 148-166, 1926.

[22] 22. KUBES, V. & GALLIS, F.: La cerebroneutralización, nueva reacción biologica para el virus rabico. Su relación com la prueba de protección y la sero-neutralización. Bol. Inst. Invest. Vet. 1:103-150,1943.

[23] 23. LIEOU, Y. C.: Carriers of rabies virus. Chin. Med. J. 66:694-699, 1948.

[24] 24. LÓPEZ, M.; NEVES, J.; MOREIRA, E.C.; REIS, R.; TAFURI, W. L.; PITTELA R. E.; MARINHO, R. P.; MARRA, U. D.; ALVARES, J. M.; DINIZ, I.; SILVA, O. S.; FOSCARINI, L. F.; CAMPOS, G. B.; MARTINS, M. T.; TOFANI, M. T.: Human rabies. I. Intensive treatment. Rev. Inst. Med. trop. São Paulo 17:103-110,1975.

[25] 25. MARTIN, L. A.: Infection rabique et rage curable. Maroc. Med. (Casablanca) 42AG1A13, 1963.

[26] 26. NEVES, J.: Raiva humana: Estudo clínico e atualização da profilaxia. Rev. Assoc. Méd. Minas Gerais 21: 13-22, 1970.

[27] 27. NILSSON, M. R.: Revisão do conceito de que a raiva é sempre fatal. Bol. Ofic. Sanit. Panamericana 68: 486-494, 1970.

[28] 28. OFFEMBERG, W.: Cas de rage guéri chez l'home. Rec. Med. Vet. 61: 559-566, 1884.

[29] 29. PAWAN, J. L.: The transmission of paralytic rabies in Trinidad by the vampire bat. Ann. Trop. Med. Parasit. 30: 101-130, 1936.

[30] 30. PÉREZ-GONZALEZ: In Martin, L. A., Infection rabique et rage curable. Marc. Med. (Casablanca) 42: 467, 1963.

[31] 31. PHILIPS, J. M.; BERRY, F. & SNOOK, J. H.: Recovery of animais apparently rabid. J. Infect. Dis. 29: 96-108, 1921.

[32] 32. REIS, R.; MOREIRA, E. C.; NEVES, J.; LÓPEZ, M.; TAFURI, W. L.; PITTELA, J. E.; MARINHO, R. P.; MARRA, U. D.; ALVARES, J. M.; DINIZ, I.; SILVA, O. R.; FOSCARINI, L.G.; MARTINS, M. T. & TOFANI, M. G.: Human rabies. II. Serological studies and intravitam virus isolation. Rev. Inst. Med. trop. São Paulo 18: 393- 401, 1976.

[33] 33. RELOVA, R. N.: Hydrophobia: its prevention and cure. S. Tomáz J. Med. 11: 259-270, 1956.

[34] 34. REMLINGER, P.: La guérison spontanée de la rage experimentale du chien et la persistance du virus rabique dans la salivedes animaus guéris. Ftéc. Méd. Vét. 84: 269-280, 1907.

[35] 35. RUBIN, R. H.; SULLIVAN, L. & SUMMERS, R.: A case of human rabies in Kansas: epidemiologic, clinical, and laboratorial consideration. J. Infect. Dis. 122 : 318-322. 1970.

[36] 36. SCHOENING, H. W.: Rabies. Proc. Sixth Pacific Science Congress (San Francisco, University of Califórnia) 5: 191-196, 1969.

[37] 37. SCHNEIDER' L. G. & SCHOOP, U.: Pathogenesis of rabies and rabies-like viruses. Ann. inst. Pasteur (Paris) 723:469-476, 1972.

[38] 38. SIKES, R. K.: Guidelines for the control of rabies. Am. J. Pub. Hith. 60: 1133-1138, 1970.

[39] 39. STARR, L.; SELLERS, T. E. & SUNKES, E. J.: Apparent recovery of a dog from rabies. JAMA 121: 296, 1973.

[40] 40. STEELE, J. H.: The epidemiology and control of rabies. Scand. J. Infect. Dis. 5: 299-312, 1973.

[41] 41. THIÉRY, J.: Un chien d'apparence saine peut-il transmettre la rage? Rev. Gen. Med. Vet. 58:451-460, 1929.

[42] 42. VEERARAGHAVAN, N.; GAJANANA, A. & R A IMG ASA Ml, R.: Hydrophobia among persons bitten by apparently healthy animais. The Pasteur Institute of Southern India. Coonoor, Sci. Rep. 19: 90-91,1967.

[43] 43. VEERARAGHAVAN, N.: Hydrophobia among persons bitten by apparently Healthy animais. The Pasteur Institute of Southern India. Coonoor Sci. Rep. 19:71,1968.

[44] 44. VELLA, E. C.: Correspondence. Lancet 5: 277, 1972.

[45] 45. WEBSTER, L. T.: A mouse test for measuring the immunizing potency of antirabies vaccines. J. Exp. Med. 70: 87-106,1939.

[46] 46. WEBSTER, L. T.: Rabies. McMillan Co., New York, 1942.

[47] 47. YOURKOVSKY, A. M.: Hydrophobia following the bite of apparently healthy dogs. J. Hyg. Epidm. (Praha) 6: 73-78,1962.