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Published On: Sun, Sep 16th, 2012

Indian man dies from rabies 25 years after dog bite

While that vast majority of human rabies cases have an incubation period of less than 90 days, researchers from Goa Medical College (GMC), in Goa, India suspect they have a case of the deadly viral disease in a man who was possibly exposed to a rabid dog a quarter of a century ago.

rabies

This rabid dog has saliva dripping from the mouth, which is a primary indicator for the presence of this disease. Image/CDC

The highly unusual case is documented in the recent issue of the Annals of Indian Academy of Neurology.

The 48-year-old man from Karnataka working in Goa was diagnosed with rabies in 2009, 25 years after receiving a dog bite on the leg at the age of 23.

This was the only known contact he had according to the man’s own medical history. He was never treated or vaccinated against the virus when the biting incident occurred.

According to the case report:

During the clinical examination, he was anxious and scared at the sight of water, flow of air under a fan and had photophobia, as noted by the medical residents and consultants. Two days after admission, suddenly, he went to the bathroom, washed his face and drank a glass of water. The photophobia and aerophobia had reduced. He was conscious, alert and well oriented to time and space and did not have laryngeal stridor or pharyngeal spasm. He had no previous history of any neurological illness or seizure disorder prior to admission to this hospital. Although the features of hydrophobia and photophobia suggested rabies encephalitis, he had a well-maintained consciousness level with no neurological deficits and the act of drinking water cast doubt on the diagnosis and he was referred to the general hospital for further management. However, he went to a private hospital in the zone. Within a few hours, he had hematemesis and he aspirated and succumbed.

Upon autopsy, histologic examination suggested  an encephalitic pathology.

In addition, the presence of intraneuronal Negri bodies were noted in the neurons. Researchers say the inclusions could be specifically immunolabeled with antibody to nuclear capsid protein of rabies virus thus establishing the definitive diagnosis of rabies encephalitis.

Virology studies could not be performed as the brain was received in 10% formalin.

The scientists note that the vast majority of rabies cases appear within one year incubation, most of these within 3 months:

Majority of the cases have an incubation period between 31 and 90 days. In the literature, the overall reported incubation period varies from 30 days in 30% of the cases, 31-90 days in 54%, greater than 90 days in 15% and in 1% of the cases beyond 1 year is recorded. In a cohort of 47 cases studied following autopsy at a single center in South India, the median incubation period recorded was 60 days (range 7 days to 4 years).

They point out documented cases  of extended length incubation such as a case in a Vietnamese girl who immigrated to Australia who had an incubation period exceeding 6.5 years. They also note that other cases seen have shown incubation times of up to 19 years.

Researchers have not ruled out the theoretical possibility of another recent insignificant exposure to the virus-carrying animal vector could not be ruled out completely, such as a dog lick on a minor scratch for example.

The study closes with the following statement:

We wish to suggest that giving credence to the actively forthcoming clinical history from a cognitively sound and conscious patient before death correlating with pathological diagnosis and acknowledging the rare cases of rabies with long incubation period is essential to further the knowledge about the phenomenon of very long incubation in cases of rabies encephalitis, although the evidence in the present case is, to an extent, tentative. The anatomical site of viral latency and the mechanism of reactivation of rabies, a neurotropic virus, remains an enigma to be unraveled.

According to the website http://www.worldrabiesday.org, rabies in humans is 100% preventable through prompt appropriate medical care. Yet, more than 55,000 people (20,000 in India according to the paper), mostly in Africa and Asia, die from rabies every year  – a rate of one person every ten minutes. The most important global source of rabies in humans is from uncontrolled rabies in dogs. Children are often at greatest risk from rabies. They are more likely to be bitten by dogs, and are also more likely to be severely exposed through multiple bites in high-risk sites on the body. Severe exposures make it more difficult to prevent rabies unless access to good medical care is immediately available. This major source of rabies in humans can be eliminated through ensuring adequate animal vaccination and control, educating those at risk, and enhancing access of those bitten to appropriate medical care.

Source:

Shankar SK, Mahadevan A, Sapico SD, Ghodkirekar M, Pinto R, Madhusudana SN. Rabies viral encephalitis with proable 25 year incubation period!. Ann Indian Acad Neurol [serial online] 2012 [cited 2012 Sep 16];15:221-3. Available from: http://www.annalsofian.org/text.asp?2012/15/3/221/99728

Image/CIA

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About the Author

- Writer, Co-Founder and Executive Editor of The Global Dispatch. Robert has been covering news in the areas of health, world news and politics for a variety of online news sources. He is also the Editor-in-Chief of the website, Outbreak News Today and hosts the podcast, Outbreak News Interviews on iTunes, Stitcher and Spotify Robert is politically Independent and a born again Christian Follow @bactiman63

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  1. India reports human rabies death, five years after dog bite | Outbreak News Today says:

    […] of human rabies are rare but not unheard of. Several years ago, a case was reported, also in India, of a man who died from rabies some 25 years after receiving an animal […]

  2. Costa Rica reports 2nd human rabies death in 2014 | Outbreak News Today says:

    […] Dr. Solano said the incubation period for rabies is usually eight to ten weeks, but in rare cases can last more than twelve months (in one case, researchers report on a case in India where the incubation was 25 years!). […]

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