Case reportUnique clinical and imaging findings in a first ever documented PCR positive rabies survival patient: A case report
Section snippets
Why this case is important?
Rabies is a disease that results in fatal encephalitis caused by RNA virus that continues to be a major public health problem in Asian and African countries with global annual mortality of 61,000 human deaths [1] and 20,000 deaths in India [2]. Though rabies is still considered 100% fatal, occasional survivors have been reported [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14] (Table 1).We report the survival of a patient, with neurological sequelae, 4½ years after
Case description
An eight-year old boy presented to our hospital with neurological disturbances of 4½ years duration Fig. 1. He sustained a dog bite at the age of four years (2010) on the face following which he received rabies immunoglobulin and rabies vaccine (purified chick embryo cell vaccine – Rabipur – Day 0,3,7,14). Details of the dog were unavailable. On day 25 after the dog bite (Fig. 1(a,b)), he developed generalised body aches, fever, seizures and altered sensorium. MRI showed T2 and Flair
Other similar and contrasting cases in the literature
Other similar cases of PCR positive Rabies survival (except in the initial 1-2 months) cases has not been reported as illustrated in Table 1.
Discussion
Though rabies is preventable following post-exposure prophylaxis, it is almost always fatal once clinical manifestations develop. In the literature, 11 cases (including this one) have been published of patients who survived clinical rabies. Probably, based on unpublished reports, more survival cases exist (Table 1; Fig. 1(a,b)). Four (30.8%) of them had complete recovery while the rest, including our patient, had moderate to severe neurological sequelae in the form of quadriparesis and
Conflict of interest declaration
None
Funding
None
Competing interests
None declared
Ethical approval
Not required. Patient fathers consent form available.
Contributorship statement
Concepts: Netravathi M, Udani V, Reeta S Mani, Gadad V, Ashwini MA, Bhat M, Mehta S, Chowdhary A, Pal PK, Madhusudana SN, Satishchandra P.
Design: Netravathi M, Reeta S Mani, Bhat M.
Definition of intellenctual content: Netravathi M, Udani V, Reeta S Mani, Mehta S, Chowdhary A, Pal PK, Madhusudana SN, Satishchandra P.
Literature research: Netravathi M, Udani V, Reeta S Mani, Gadad V, Ashwini MA, Bhat M, Mehta S, Chowdhary A, Pal PK, Madhusudana SN, Satishchandra P.
Clinical study: Netravathi M,
Acknowledgement
None
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Therapy of human rabies
2020, Rabies: Scientific Basis of the Disease and Its Management, Fourth EditionEvaluation of in vitro inhibitory potential of type-I interferons and different antiviral compounds on rabies virus replication
2019, VaccineCitation Excerpt :In the absence of preventive or post-exposure vaccination the disease is almost invariably fatal: after the onset of clinical signs there is no treatment protocol that could save the life of infected patients, leading to the death of more than 60 000 people every year, which number is probably underestimated [1]. To date, less than 20 survivors of rabies were reported, predominantly with severe neurological sequelae [2–7]. Efforts to establish reliable therapeutic strategies have been unsuccessful yet.
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2019, Brain Research BulletinCitation Excerpt :Taken together, the results in experimental animals and in humans indicate that a disintegration of sleep and wake progresses to brain death in rabies encephalitis. Recently, an EEG study in a report of an exceptional survivor to rabies showed slow background activity 5–6 Hz and frequent spikes and sharp waves (Netravathi et al., 2015). In February 2016, WHO focused attention on Zika virus (ZIKV), declaring it a Public Health Emergency of International Concern (Gulland, 2016).
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2024, Indian Journal of Medical Research
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Present address: Department of Pediatrics and Neurology, Hinduja National Hospital, Veer Savarkar Marg, Mumbai 400016.