Case Report: Survival from Clinical Rabies in a Young Child from Maharashtra, India, 2022

Padinjaremattathil Thankappan Ullas Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India;

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Chandhu Balachandran Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India;

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Nikhil Pathak Kamalnayan Bajaj Hospital, Aurangabad, India;

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Yadav Prasad Manikrao Kamalnayan Bajaj Hospital, Aurangabad, India;

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Shailesh Rathod Kamalnayan Bajaj Hospital, Aurangabad, India;

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Daya Vishal Pavitrakar Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India;

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Vijay Parashramji Bondre Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India;

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Priya Abraham Director, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India

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ABSTRACT.

A 3.5-year-old male child from Maharashtra, India, presented with features of meningoencephalitis approximately 1 month after sustaining severe bite injuries on the right hand from a stray dog. He had received four doses of post-exposure intradermal rabies vaccination (on days 0, 3, and 7 of the bite and erroneously on day 20, instead of day 28 as recommended in the updated Thai Red Cross regimen) as well as local and systemic injections of equine rabies immune globulin. The child was initially diagnosed with and treated for acute encephalitis syndrome before rabies encephalitis was confirmed by detection of rabies virus neutralizing antibodies in the cerebrospinal fluid. During the emergent period, he also received the antimalarial drug artesunate, recently reported to have antiviral effects against rabies virus. With intensive and supportive care, the child showed substantial clinical improvement over the next few weeks. He has now survived for more than 10 months after disease onset, albeit with severe neurological sequelae including diffuse cerebral and cerebellar atrophy.

Author Notes

Financial support: We also acknowledge support received from the Indian Council of Medical Research-National Institute of Virology, Pune, India.

Authors’ addresses: Padinjaremattathil Thankappan Ullas, Chandhu Balachandran, Daya V. Pavitrakar, and Vijay Parashramji Bondre, Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India, E-mails: ullaspt@gmail.com or ullas.pt@gov.in, chandhubala20@gmail.com, dayapavitrakar@gmail.com, and vpbondre@gmail.com. Nikhil Pathak, Yadav Prasad Manikrao, and Shailesh Rathod, Kamalnayan Bajaj Hospital, Aurangabad, India, E-mails: nikhilpathak26@gmail.com, pmyadav142@gmail.com, and shaileshrathod108@gmail.com. Priya Abraham, Director, Indian Council of Medical Research-National Institute of Virology (ICMR NIV), Pune, India, E-mail: priyaabraham@cmcvellore.ac.in.

Address correspondence to Padinjaremattathil Thankappan Ullas, Rabies Laboratory, Encephalitis Group, Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pashan, Pune 411021, Maharashtra, India. E-mails: ullas.pt@gov.in, ullaspt@gmail.com
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