Elsevier

Journal of Clinical Virology

Volume 70, September 2015, Pages 83-88
Journal of Clinical Virology

Case report
Unique clinical and imaging findings in a first ever documented PCR positive rabies survival patient: A case report

https://doi.org/10.1016/j.jcv.2015.07.003Get rights and content

Highlights

Abstract

Background

Rabies is fatal encephalitis which is a major public health problem in Asian and African countries. Till date, only 12 cases have been reported who have survived after rabies. Case Report: In this communication we report a patient who is unique as the first documented long term rabies survivor with PCR positivity even after 4½ years of illness. Child sustained dog bite following which he received adequate prophylaxis. Within two weeks, child developed encephalopathy requiring evaluation. Child continues to have persistent myoclonic jerks, seizures, is dependent on all activities with severe neurological deficits. Nested reverse transcriptase PCR (RT-PCR) specific for rabies nucleoprotein gene in CSF and nuchal skin biopsy were positive for rabies viral RNA. The nuchal skin biopsy was also positive for rabies nucleoprotein antigen by fluorescent antibody test (FAT). We describe the clinical evolution and sequential MRI brain changes in this child.

Conclusions

Despite the uniformly dismal prognosis of human rabies, these unusual reports of survival of rabies patients may provide an impetus to explore newer therapeutic strategies for this otherwise fatal disease.

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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    • Cited by (0)

    1

    Present address: Department of Pediatrics and Neurology, Hinduja National Hospital, Veer Savarkar Marg, Mumbai 400016.

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