Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report
Abstract 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 animals. We discuss the challenges in th...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | Infectious Diseases of Poverty |
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| Online Access: | https://doi.org/10.1186/s40249-023-01148-2 |
| _version_ | 1827632703799820288 |
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| author | Thinley Dorji Jeewanath Lamichaney Choeda Gyaltshen Lungten Lungten Guru Prasad Dhakal Sithar Dorjee Mimi Lhamu Mynak |
| author_facet | Thinley Dorji Jeewanath Lamichaney Choeda Gyaltshen Lungten Lungten Guru Prasad Dhakal Sithar Dorjee Mimi Lhamu Mynak |
| author_sort | Thinley Dorji |
| collection | DOAJ |
| description | Abstract 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 animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting. Case 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 sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality. Conclusions This case called for a serious evaluation of the country’s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases. Graphical Abstract |
| first_indexed | 2024-03-09T14:49:18Z |
| format | Article |
| id | doaj.art-5fb9229f24014820a18fc1c28710cd3b |
| institution | Directory Open Access Journal |
| issn | 2049-9957 |
| language | English |
| last_indexed | 2024-03-09T14:49:18Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Infectious Diseases of Poverty |
| spelling | doaj.art-5fb9229f24014820a18fc1c28710cd3b2023-11-26T14:34:04ZengBMCInfectious Diseases of Poverty2049-99572023-10-011211710.1186/s40249-023-01148-2Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case reportThinley Dorji0Jeewanath Lamichaney1Choeda Gyaltshen2Lungten Lungten3Guru Prasad Dhakal4Sithar Dorjee5Mimi Lhamu Mynak6Department of Internal Medicine, Central Regional Referral HospitalDepartment of Internal Medicine, Central Regional Referral HospitalDepartment of Internal Medicine, Central Regional Referral HospitalRegional Veterinary Hospital and Epidemiology CentreFaculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of BhutanOffice of the President, Khesar Gyalpo University of Medical Sciences of BhutanOffice of the President, National Medical Services, Ministry of HealthAbstract 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 animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting. Case 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 sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality. Conclusions This case called for a serious evaluation of the country’s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases. Graphical Abstracthttps://doi.org/10.1186/s40249-023-01148-2RabiesOutbreakEncephalitisLyssavirusMyelitisNeglected diseases |
| spellingShingle | Thinley Dorji Jeewanath Lamichaney Choeda Gyaltshen Lungten Lungten Guru Prasad Dhakal Sithar Dorjee Mimi Lhamu Mynak Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report Infectious Diseases of Poverty Rabies Outbreak Encephalitis Lyssavirus Myelitis Neglected diseases |
| title | Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report |
| title_full | Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report |
| title_fullStr | Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report |
| title_full_unstemmed | Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report |
| title_short | Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report |
| title_sort | human rabies encephalomyelitis in the background of rabies outbreak in animals in gelephu bhutan 2023 a case report |
| topic | Rabies Outbreak Encephalitis Lyssavirus Myelitis Neglected diseases |
| url | https://doi.org/10.1186/s40249-023-01148-2 |
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