A Child Surviving Rabies

A report describes a case of a 6-y-old girl who presented with high fever, headache, ataxia, and behavioral disorders. She had a history of being bitten by a stray dog on the left side of her face two weeks earlier. 

She acquired four doses of antirabies vaccine and rabies immunoglobulin; and displayed no classical signs of rabies-like hydrophobia, aerophobia, or agitation. Rabies encephalitis and vaccine-induced acute disseminated encephalomyelitis (ADEM) were considered potential diagnoses. 

MRI of the brain and spine displayed hyperintensities in T2 and FLAIR images involving the dorsal brain stem, thalamus, and cervical-dorsal marrow. Her CSF PCR was negative for rabies. The CSF rapid fluorescent focus inhibition test (RFFIT) for rabies antibodies documented rabies virus-neutralizing antibody titer of 1:30 UI/ml.

On the third day of admission, the patient's neurological status deteriorated severely; she was comatose with a modified Glasgow Coma Scale of 9. However, she maintained her airway and ventilation and did not require intubation. The patient received supportive treatment with nasogastric feeds and vitamin supplements. 

Despite physiotherapy, the patient developed severe spastic quadriparesis. The last MRI on Day 61 showed extensive atrophy of the supra and infratentorial brain. A repeat serum RFFIT antibody titer on Day 66 was 1:488 UI/ml, and the CSF antibody titer was 1:23.

The child stayed at the hospital for three months and then received a discharge with severe neurological sequelae, including quadriplegia and visual impairment. She remained alive at 12 months follow-up.

Asma BH, Amal E, Hela F., et al. A Child Surviving Rabies in Tunisia: A Case Report. Indian J Pediatr. 2023. https://doi.org/10.1007/s12098-023-04856-7