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There are several possibilities. Creutzfeldt-jakob disease,
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tick-borne encephalitis, but the most likely culprit is rabies,
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and that wouldn't show up in an autopsy except in brain tissue.
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So since Lewis was the only victim not bitten by a human,
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the unsub must have used an animal to infect him first.
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And after that, he somehow facilitated human to human transmission.
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That would explain the random victimology.
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It doesn't matter who he infects.
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All he needs is a host.
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Which also means the holding period
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isn't about torture, it's about incubation.
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I was attacked by a rabid fox once.