Difficulties in diagnosing rabies using the example of a clinical case in the Omsk region

Abstract

Rabies is the deadliest zoonotic disease caused by the rabies virus, a member of the genus Lyssavirus. The disease occurs after a bite from a wild or domestic animal. The paper presents a clinical case of rabies with early diagnostic difficulties, particularlyclinical, epidemiological, and laboratory diagnostic features, in a patient suffering from alcoholism. The victim sought medical help 20 days after the dog bite. On day 29, a hydrophobia clinic was observed. The patient exhibited signs of visual and auditory hallucinations, aggressiveness, and disorientation in place and time, which resembled the development of alcoholic psychosis. Saliva samples were collected on day 3 of the disease, and its polymerase chain reaction test was negative for rabies virus. On day 29, the patient died. The diagnosis of rabies was confirmed antemortem and posthumously. The virus was detected in the saliva on day 9 of the disease and posthumously in the cerebral cortex, medulla oblongata, cerebellum, and salivary glands. Histologically, Babesh–Negri bodies were found in the brain tissue. Necessary preventive measures were implemented. The unfavorable outcome in the described case of rabies emphasizes the lack of awareness of the population (especially rural) about the risk of contracting rabies infection through contact with animals and the importance of timely post-exposure prophylaxis. Timely anti-rabies care remains the only effective means of preventing related deaths.