Creutzfeldt-Jakob disease.

Cruetzfeldt-Jakob disease is a prion protein disease causing a transmissible, subacute, fatal neurodegenerative disease characterized by a spongiform encephalopathy. Though rare, ever since Pruisner described the pathogenesis in 1982, this disease kept the clinicians as well as biologists spellbound, because of its distinct clinical picture and the novel mechanism of transmission. There was a further quantum leap in the interest in the disease with the establishment of its new clinical variant, the so called 'mad cow disease' in the late 1990s and had led to more stringent measures to ensure the quality of cattle-feeds and cattle-derived food products. The sporadic genetic variants, the commonest form of the disease, continue to challenge the genetic scientists. Advances in neuroimaging, cerebrospinal fluid marker proteins and genetic linkage studies now offer excellent diagnostic methods, while advances in therapeutic medicine which use products from cadaveric extracts such as growth hormone for treatment of hypopituitarism, dural grafts for neurosurgical procedures and cornea for transplantation etc. have thrown new challenges in controlling this serious disease.

Bite by a dog under provocation: is it free from risk?

There is a common belief that rabid dogs bite without provocation, hence a dog bite under provocation is free from the risk of rabies. This is not always true as is evident from the case report narrated below. Here in this article, a man of 38 years was bitten by a dog under provocation. He developed rabies 4 months after the bite and subsequently died. Autopsy revealed Negri bodies from the brain tissue.

Human rabies in India: epidemiological features, management and current methods of prevention.

In most endemic countries stray dogs are the main source of rabies infection in humans. In India 95-97% of rabies patients are infected by dogs. Most pet dogs do not regularly receive booster doses of vaccine. In Thailand, most rabies patients develop the disease within 1 month of exposure. Rabies immunoglobulin is costly and usually not available. So in India nervous tissue vaccine is commonly used--it is inexpensive and freely available despite frequent neurological complications. The cost of immunization by tissue culture vaccines may be reduced by nearly 60% by intradermal vaccination.

Fulminant infection by uncommon organisms in animal bite wounds.

In 1995 and 1996, 215 patients exposed to different species of animals were treated at the Amarnath Polyclinic, Balasore, in India. Among them were two children infected by uncommon organisms, i.e., Capnocytophaga canimorsus and Pasteurella multocida; the patients recovered with appropriate antibiotic therapy.

Excessive libido in a woman with rabies.

Rabies is endemic in India in both wildlife and humans. Human rabies kills 25,000 to 30,000 persons every year. Several types of sexual manifestations including excessive libido may develop in cases of human rabies. A laboratory proven case of rabies in an Indian woman who manifested excessive libido is presented below. She later developed hydrophobia and died.

Treatment of clinical rabies in man: drug therapy and other measures.

The treatment of symptomatic rabies is a challenging problem; no specific drug is yet available. Isolation in intensive care unit with symptomatic and supportive measures is the mainstay of treatment at present. Antiviral drugs, particularly interferon and interferon-inducers, have been employed with variable results. Corticosteroid is not effective. Anti-rabies vaccine has no proven efficacy in treatment. Effective treatment of systemic complications during survival period with appropriate therapy is essential.