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Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu,Bhutan,2023:a case report

Infectious Diseases of Poverty 2023年第5期12卷 102-102页

作者： Thinley Dorji Jeewanath Lamichaney choeda gyaltshen Lungten Lungten Guru Prasad Dhakal Sithar Dorjee Mimi Lhamu Mynak Department of Internal Medicine Central Regional Referral Hospital Gelephu Bhutan Regional Veterinary Hospital and Epidemiology Centre Gelephu Bhutan Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan Office of the President Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan Office of the President National Medical Services Ministry of Health Thimphu Bhutan

Background Rabies continues to pose significant public health challenges in many developing countries including Bhutan.A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild *** discuss the challenges in the diagnosis and management of rabies in a resource-limited *** presentation A 35-year-old male presented with intermittent fever,bilateral lower limb weakness that was rapidly progressive,urinary incontinence with episodes of palpitations and *** had sustained a Category III bite on the right lower thigh with four bite marks,inflicted by a stray *** had received post-exposure prophylaxis with intra-dermal anti-rabies *** initial examination,the patient was in distress but cooperative for the *** had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations,but with normal capillary blood *** the lower limb,the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 *** had hyperaesthesia below T8,hydrophobia,aerophobia and *** had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles,neck and face *** had altered sensorium and desaturation for which he required mechanical *** chain reaction for rabies virus was negative in cerebrospinal fluid and *** virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the *** received Human Rabies Immunoglobulin after *** was managed in the intensive care unit and died 23 days *** this case was notified,a rapid response team was deployed in the field,and uncovered rabies outbreak in animals in the *** This case called for a serious evaluation of the country’s efforts in achieving zero rabies deaths by *** management of this case identi

关键词： Rabies Outbreak Encephalitis Lyssavirus Myelitis Neglected diseases One Health Tropical medicine

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