As I [understand it](https://www.israel21c.org/how-rabies-goes-from-bite-site-to-brain/), unlike most pathogens, rabies travels through the body (from the infection site to the brain) via the nerve-cell network, not through your bloodstream where your immune system is most powerful. Resultantly, it’s much more difficult to treat than other types of infections.
Imagine this virus sneaking into your body, usually through an animal bite. Once it’s in, it’s on a mission to mess things up big time.
It heads straight for your brrain, the boss of your body. And here’s where the trouble begins. It starts confusing your brain, like giving it mixed up signals. Imagine your brain trying to do its job but getting all jumbled.
This confusion is what makes rabies deadly. You start feeling sick, tired, and sometimes even furious or scared. Your behavior might go bonkers you could act like a whole different person or animal.
As this sneaky virus keeps wreking havoc, your body goes haywire too. Muscles get all twitchy, swallowing becomes a challenge it’s a mess. That’s why some with rabies folks drool or struggle to drink.
Once the virus reaches this stage, it’s usually game over. Your body and brain go into a omega sick mode, and unfortunately, many people and animals don’t make it out alive.
[Kurzgesagt](https://www.youtube.com/watch?v=4u5I8GYB79Y) made a good video of it that goes into details.
The broad view is that it infects your nervous system and then gets into your brain. Your brain is a delicate organ, so it usually enjoys some privileges when it comes to your immune system.
Viral infections are tough to medicate (partially because viruses aren’t really “alive” and that means there are fewer ways of “killing” them) so if your own immune system is waiting the fight out, there’s not much that medicine can do for the patient.
I went on a rabies deep-dive many years ago and was interested to read this:
[https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007933](https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007933)
(preface, I am not a doctor or a scientist)
Essentially, while yes, rabies is EXTREMELY deadly, and every exposure should be treated as a life-or-death situation with post-exposure prophylaxes given to even suspected bites/scratches from wild animals… the 100% fatality in untreated people might not be quite accurate.
Aside from the few Milwaukee protocol survivors (between 5 and 18 depending on who you read), untreated rabies has been considered to be 100% fatal in unvaccinated humans.
This study, however, seems to suggest that some seriological studies of people in-rabies areas, like some places in Africa and India, seem to show rabies antibodies despite never having been sick with rabies, or having been vaccinated. This means they encountered the virus in the wild, were exposed, and it never became clinically relevant, and certainly not fatal.
These might have been glancing blows, where only the tiniest amount of rabies made it into the body, and somehow, the immune system managed to take it out before it migrate through nerves.
Alternately, these people may have been ill at some point in their life with an unknown infection, which while having cleared up, WAS rabies, and they never knew it.
That said, rabies is likely about as close to 100% fatal as any disease can get, so… if you are bitten/scratched by an unknown mammal, please immediately go to the hospital for post-exposure prophylaxis. The sooner the treatment is given, the better your odds. And the odds for treated individuals ARE GOOD! like 100% good… Granted some of it has to do with the location of the bite, etc… a bite directly into the spinal cord, near the brain, etc, might not leave enough time for treatment but that is absurdly rare, and as far as I know, no one treated within 24 hours of an exposure has died of rabies.
There is this thing called the blood-brain barrier, which basically puts your brain in a separate category from the rest of your body. Most pathogens can’t pass through that barrier, and most drugs as well.
The rabies virus is one of the few pathogens that can cross that barrier, and once it starts making havoc in the brain (creating a fear of water, paranoia, mood swings, erratic behavior, seizures, death) it is basically impossible to treat.
You have to cath it before symptoms start, either by being inoculated against it (rabies vaccine) or by some immediate treatment within hours of infection.
This is why when rabies is even a remote possibility, people recommend getting to an ER as soon as humanly possible.
Rabies isn’t too much deadlier than other pathogens, the problem is the period of symptoms.
Imagine an infection which is so sneaky that you won’t feel it until the moment it has already killed you, and you get rabies. Just like other infections and pathogens it still takes days or weeks to kill, but it doesn’t give you any real symptoms until it hits your brain and by that time you can’t recover.
So yes rabies kills all people who present symptoms because the only symptom is beyond the recovery period.
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