Tollwut (Rabies, Lyssa)

Rabies is one of the so-called lost diseases in Germany despite every year more than 55.000 cases occur worldwide and more than 10 million post-exposition immunisations are being accomplished. The disease is caused by a virus. After a bite by a bat or, more often, a fox in Central Europe, or a dog in Africa, Asia or South America or any other animal the virus is being incorporated in muscle cells, multiplies and after a while gets access to nerve cells. The virus attaches e.g. to acetylcholine receptors, is transported via the axon to the brain where it reproduces intracellularly. Infected nerve cells change their function. Incubation period up to the appearance of any signs and symptoms is approximately 2 weeks to months. Signs and symptoms are encephalitis or paralysis followed by hypersalivation, hydrophobia, coma and death. In people who have no vaccine protection and do not receive post-exposure vaccination the disease is lethal throughout. There is no antiviral therapy available. Rabies can be prevented by pre-emptive immunisation or after injuries of the lower limb by post-exposure prophylaxis. Natural hosts are small rodents, bats, and carnivores; in this respect rabies is a zoonotic disease and the virus can not be extinguished.