**5. Conclusion**

In Eastern Siberia lyssavirus isolated for the first time from a bat (*Murina leucogaster*) was reported in September, 2002. The bat, which looked healthy, entered into the house in Ir‐ kutsk. It was caught and observed. On the tenth day of its observation the symptoms of dis‐ ease appeared which has resulted in fatal outcome. The virus called Irkut [Botvinkin et al., 2003] was isolated from the brain of the dead animal. During the strain isolation the infected suckling mice had 18 days of the incubation period, and among these mice only one fell ill. At the second passage the incubation period varied from 9 to 18 days. Moreover, it should be noted that the bat infected with Irkut strain wounded the girl, but the illness did not de‐

Both cases in Irkutsk and Primorye Territory confirm that usually sick animals enter into hu‐ man dwellings. First of all such animals are of a special danger and require to take measures which protect people from the possible accidental contacts with them. Other cases of lyssa‐ virus infection in Europe reported by Botvinkin et al. (2003) look very similar to these ones. Unfortunately, the final diagnosis in studied case of infection was stated postmortem. The isolation of Ozernoe strain revealed the following facts to pay attention to: a short incuba‐ tion period up to 6-7 days; the examined suckling mice of a mouse family fell ill at the same time. If the suckling mice were challenged intracerebrally, the virus titre in the brain of the dead patient was evaluated as 3.7 lg LD50. In the first passage the titre of Ozernoe strain in the mice challenged intracerebrally reached 6 lg LD50. Hаemagglutinins were found not only in brain of the infected mice, but also in the brain of the dead patient. These data indicate a high virus concentration which caused profound brain damages and the overall visceral in‐ jury followed by impairment of vital functions and resulted in the imminent fatal outcome. The postmortem analysis indicated the changes characteristic for rabies: extensive destruc‐ tive changes of neurons, formation of many neuronophagic nodules like "rabies nodules", an evident spongy endema of the medullary substance. At the same time, a clearly defined in‐ flammatory reaction around blood vessels was not found. This fact together with the found changes in lymphoid organs indicated the immunodeficiency state, which was undoubtedly

The presence of extracellular viral particles with morphology similar to the structures of Rabies virus on cell surface membranes and spreads forming the electron-dense sub‐ stance in cellular cytoplasm were revealed during the ultrastructural study. Extracellular viral particles in the environment were distinctly observed and had the morphological signs typical for the group of enveloped viruses with spikes on the surfaces [Iseni, 1998]. The oval and dense bodies (with diameter about 2550 nm) were determinated in cyto‐ plasm and mainly in extracellular environment of PEG cells culture infected by strain Ozernoe. These structures were described earlier as Negri bodies in neurons infected by

To identify exactly the virus genotype the fragment of N gene was amplificated and se‐ quenced. Moreover, the search for homologous sequences in GeneBank using BLAST pro‐ gram has given the absolute evidence that the closest relative of Ozernoe strain is Irkut strain isolated earlier from the bat in Eastern Siberia. Since the Ozernoe strain is the first strain of the genotype 8 isolated from a dead human, we have determined its complete ge‐

velop due to the timely vaccination against rabies.

244 Encephalitis

associated with the virus infection.

Rabies virus [Velandia et al., 2007].

The clinical and epidemiological characteristics of fatal human case of lyssavirus infection identified fort he first time in the Asian part of Russia were provided. The evidence that this case belongs to Lyssavirus infection in the terms of etiology was obtained based on the data of epidemiological anamnesis, clinical picture of infection as well as the virological, morpho‐ logical, and molecular genetic studies. The pathologic diagnosis was the acute stage of me‐ ningoencephalitis as underlying disease with complications of edema, swelling and dislocation of brain, the formation of neuronophagic nodules like "rabies nodules" mainly in the subcortical brain as well as bilateral hypostatic pneumonia and parenchymatous degen‐ eration of myocardium, liver and kidney. The study by electron microscopy revealed that the viral particles of 100 nm in diameter could also be associated with the vesicles close to the endoplasmic reticulum or Golgi apparatus. The complete genome sequence of Ozernoe strain is 92% identical to the complete genome of Irkut strain and 77-78% to EBLV-1 ge‐ nome. The phylogenetic analysis based on the complete genome sequences revealed that Ozernoe strain, isolated from the brain of the dead patient, and Irkut strain, isolated in Ir‐ kutsk from the brain of a bat, are located on the same branch of the phylogenetic tree and have the common ancestor. So the real possibility of serious Lyssavirus infection in cases when people have accidentally encountered with chiropteran was demonstrated.

This case has ended in fatal outcome because of the fact that doctors have never registered patients with a lyssavirus infection in the Far East before. Therefore, it was difficult to make the right decision for emergency vaccination against rabies after the accidence as it is usually done in the cases of classical rabies. The exact diagnosis was not get, the clinical course of infection was rapid and following remedial actions have been unsuccessful.

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The Fatal Case of Lyssavirus Encephalitis in the Russian Far East

http://dx.doi.org/10.5772/52869

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