Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
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Volume 12, Number 2, April 2021, pages 53-59

Rabies and the Heart


Figure 1.
Figure 1. (a) Human deaths from rabies. (b) Death rates per capita (per 100,000 population); countries shaded in grey are free from canine rabies (Adapted from: TRS 3rd report, 2017,
Figure 2.
Figure 2. PRISMA flow diagram demonstrating search strategy used. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 3.
Figure 3. Mechanism of rabies infection.


Table 1. Diagnostic Tests for Rabies
  Conventional RT-PCR
    Target: viral nucleic acid
    Advantages: rapid, high sensitivity and specificity, amplicons can be used for genetic characterization
    Disadvantages: requires specialist equipment, potential for contamination
  Fluorescent antibody virus neutralization (FAVN) and rapid fluorescent focus inhibition test (RFFIT)
    Target: virus-neutralizing antibodies
    Advantages: useful for assessment after vaccination
    Disadvantages: long turnaround time, incompatible with ante-mortem confirmation of diagnosis, as antibodies are usually detected after the onset of clinical signs, requires specialist containment and operator expertise
  Fluorescent antibody test (FAT)
    Target: virus antigen
    Advantages: rapid, high sensitivity and specificity
    Disadvantages: expensive conjugate, requires an ultraviolet light microscope
  Rabies tissue culture isolation test (RTCIT)
    Target: live virus
    Advantages: enables propagation of virus for characterization
    Disadvantages: requires specialist facilities and operator expertise, long turnaround time


Table 2. Summary of Studies Mentioning Cardiac Complications of Rabies
Study (year)Type of studyNMain findings
Pathak et al, 2014 [23]Case report1Bodies of Negri in the cardiac vagus nerve, myocarditis, dysautonomia with episodes of bradycardia
Hattwick et al, 1972 [19]Case report11st case of recovery, supraventricular and ventricular arrhythmias
Park et al, 2019 [15]Case report1ECG with ST elevation + positive biomarkers, myocarditis, 2nd degree AV block, presented as coronary syndrome
Duenas et al, 1973 [25]Cases series17Myocarditis in 10 patients
De Morais et al, 1985 [24]Case report1Myocarditis
Ross et al, 1962 [18]Case report1Myocarditis and nonspecific abnormalities of ST-T
Araujo et al, 1971 [22]Cases series23Myocarditis in 16 patients
Cheetham et al, 1970 [17]Cases series2Inflammation of the three layers of heart
Bhatt et al, 1974 [16]Case report1Heart failure, nonspecific ST-T abnormalities, bradyarrhythmias
Venkat Raman et al, 1988 [20]Case report1Bradyarrhythmias, complete left bundle branch block
Cohen et al, 1976 [21]Case report1Arrhythmias (atrial fibrillation, atrial flutter, supraventricular extrasystoles, ventricular extrasystoles, 2nd degree AV block, complete AV block)