Juntrakul Sasiwimol, Ruangvejvorachai Preecha, Shuangshoti Shanop, Wacharapluesadee Supaporn, Hemachudha Thiravat
Department of Medicine, Chulalongkorn University Hospital, Rama 4 Road, Bangkok, Thailand.
BMC Infect Dis. 2005 Nov 16;5:104. doi: 10.1186/1471-2334-5-104.
Rabies virus preferentially involves brainstem, thalamus and spinal cord in human furious and paralytic rabies beginning in the early stage of illness. Nevertheless, rabies patient remains alert until the pre-terminal phase. Weakness of extremities develops only when furious rabies patient becomes comatose; whereas peripheral nerve dysfunction is responsible for weakness in paralytic rabies.
Evidence of apoptosis and mitochondrial outer membrane permeabilization in brain and spinal cord of 10 rabies patients was examined and these findings were correlated with the presence of rabies virus antigen.
Although apoptosis was evident in most of the regions, cytochrome c leakage was relatively absent in spinal cord of nearly all patients despite the abundant presence of rabies virus antigen. Such finding was also noted in brainstem of 5 patients.
Cell death in human rabies may be delayed in spinal cord and the reticular activating system, such as brainstem, thus explaining absence of weakness due to spinal cord dysfunction and preservation of consciousness.
狂犬病病毒在人类狂暴型和麻痹型狂犬病发病早期优先侵犯脑干、丘脑和脊髓。然而，狂犬病患者直到临终前期仍保持清醒。只有当狂暴型狂犬病患者昏迷时才会出现肢体无力；而麻痹型狂犬病的无力则是由周围神经功能障碍引起的。
检查了10例狂犬病患者脑和脊髓中凋亡及线粒体外膜通透性的证据，并将这些发现与狂犬病病毒抗原的存在情况相关联。
尽管大多数区域都有明显的凋亡，但几乎所有患者的脊髓中细胞色素c泄漏相对较少，尽管狂犬病病毒抗原大量存在。5例患者的脑干中也有此发现。
人类狂犬病时脊髓和网状激活系统（如脑干）中的细胞死亡可能会延迟，从而解释了因脊髓功能障碍导致的无力缺失和意识的保留。
