Extraneural organ involvement in human rabies

Human rabies is a fatal encephalomyelitis. After the development of the central nervous system infection, there is centrifugal spread of the rabies virus to extraneural (systemic) organs. With histochemical staining and localization of rabies virus antigen (RVA) with immunoperoxidase staining, we have examined tissue sections of organs from 14 postmortem pediatric and adult cases of human rabies acquired in Mexico and the People's Republic of China. RVA was found in nerve plexuses in multiple organs, including the gastrointestinal tract. RVA was observed in muscle fibers of the heart, tongue, and larynx. RVA frequently was observed in the adrenal medulla with an associated inflammatory reaction. Minor salivary glands of the tongue contained RVA and major salivary glands showed RVA in plexuses, but not in either acini or ducts. Epithelial cells of the tongue and taste buds were occasionally infected. RVA was observed in hair follicles of the skin and rarely in pancreatic islets. The infection of extraneural organs was sometimes, but not always, associated with an inflammatory reaction. These findings indicate that centrifugal spread of rabies virus to extraneural organs occurs frequently in human rabies.