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Consulta De Expertos De La OMS Sobre La Rabia W H O T e c h n i c a l R e p o r t S e r i e s 1 0 1 2 Consulta de Expertos de la OMS sobre la Rabia Tercer informe Este informe contiene las opiniones colectivas de un grupo internacional de expertos y no representa necesariamente las decisiones o la política establecida de la Organización Mundial de la Salud Consulta de Expertos de la OMS sobre la Rabia, tercer informe (WHO Technical Report Series, No. 1012) ISBN 978-92-4-121021-8 ISSN 0512-3054 ©Organización Mundial de la Salud 2018 Algunos derechos reservados. Este trabajo está disponible bajo Creative Commons Reconocimiento- No Comercial-Compartir Igual 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/ licenses/by-nc-sa/3.0/igo). Según los términos de esta licencia, puede copiar, redistribuir y adaptar el trabajo para fines no comerciales, siempre que el trabajo se cite adecuadamente, como se indica a continuación. 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La responsabilidad de la interpretación y el uso del material recae en el lector. En ningún caso la OMS será responsable de los daños derivados de su uso. Esta publicación contiene las opiniones colectivas de un grupo internacional de expertos y no representa necesariamente las decisiones o las políticas de la OMS. Impreso en Italia. Design: WHP (Sophie Guetaneh Aguettant) Contenido Abreviaturas y siglas ............................................................................................................................... 8 1. Introducción .................................................................................................................................... 9 2. La carga de la rabia ....................................................................................................................... 10 2.1 Métodos para estimar la carga de la rabia ........................................................................... 10 2.2.1 Países libres de rabia canina ......................................................................................... 11 2.2.2 Países en los que la rabia canina es endémica ............................................................. 12 2.2.3 Rabia del murciélago ..................................................................................................... 13 2.3 Carga mundial de la rabia ..................................................................................................... 13 2.4 Referencias ............................................................................................................................ 14 3. Clasificación de los lyssavirus ....................................................................................................... 16 3.1 Características distintivas de los lyssavirus ........................................................................... 16 3.2 Criterios para diferenciar entre los lyssavirus....................................................................... 16 3.3 Estructura actual del género Lyssavirus ................................................................................ 17 3.4 Referencias .................................................................................................................................. 20 4. Patogénesis ................................................................................................................................... 22 4.1 Referencias .................................................................................................................................. 23 5. Diagnóstico.................................................................................................................................... 25 5.1 Definiciones de casos estándar de rabia ............................................................................... 25 5.2 Diagnóstico clínico ................................................................................................................ 25 5.3 Bioseguridad, muestreo y transporte de muestras para el diagnóstico de laboratorio ....... 26 5.3.1 Bioseguridad ................................................................................................................. 26 5.3.2 Muestreo para el diagnóstico ante mortem en humanos ............................................ 26 5.3.3 Muestreo para el diagnóstico post mortem en humanos y animales .......................... 27 5.3.4 Transporte de las muestras ........................................................................................... 27 5. 4 Técnicas de laboratorio para el diagnóstico post mortem de la rabia en seres humanos y animales ............................................................................................................................................ 27 5.4.1 Detección del antígeno viral ......................................................................................... 32 5.4.2 Aislamiento del virus ..................................................................................................... 32 5.4.3 Detección de ARN viral.................................................................................................. 33 5.5 Técnicas para el diagnóstico ante mortem de la rabia en seres humanos ........................... 33 5.5.1 Detección del antígeno viral ......................................................................................... 33 5.5.2 Detección de anticuerpos virales .................................................................................. 33 5.5.3 Detección de ARN viral.................................................................................................. 34 5.5.4 Aislamiento del virus ..................................................................................................... 34 3 5.6 Medición de la respuesta de los anticuerpos a la vacunación antirrábica en seres humanos 34 5.7 Medición de la respuesta de los anticuerpos a la vacunación antirrábica en animales ....... 35 5.8 Identificación del virus con técnicas moleculares: consideraciones epidemiológicas ......... 35 5.9 Referencias ............................................................................................................................ 35 6. Manejo de los pacientes antes y después de la muerte .............................................................. 38 6.1 Manejo de los pacientes con rabia ....................................................................................... 38 6.2 Manejo paliativo de pacientes con rabia .............................................................................. 39 6.3 Recomendaciones para el personal de salud y los familiares de los pacientes con rabia .... 40 6.4 Sobrevivientes de la rabia y protocolos de tratamiento “agresivos” ................................... 41 6.4.1 Cuidados intensivos (tratamiento sintomático) ........................................................... 41 6.4.2 Tratamiento específico para la rabia ...........................................................................
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