Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinical features of rabies encephalopathy are highly nonspecific at the onset and clinicians from low endemic areas usually face difficulties in recognizing cases during the early stages. The need for establishing a rapid and accurate test to identify rabies during the ante-mortem period is important. However, in actual clinical practice, the latter may remain difficult for various reasons. In human rabies, positively identifying the antigen, antibody or genetic material by various diagnostic methods during the symptomatic period is affected by the unpredictable nature of viremia, levels of antibody immune response of the host, and the virulence of the infecting strain. Also, more advanced testing with greater sensitivity may not be readily available at all centers. Here we describe a case of a young male who was bitten by a rabid dog and developed progressive encephalopathy with a fatal outcome, with negative antibodies in the cerebrospinal fluid (CSF). A review of the literature on the clinical features, diagnostic tests, treatment and prevention of rabies is also presented.
Tuberculosis (TB) remain as one of the leading opportunistic infection in patients with Human immunodefficiency virus (HIV) infection in developing countries. Here we report a case of huge primary psoas abscess of tubercular origin in an HIV patient who presented with hip pain and limping. Psoas sign was evident on examination and CT scan of abdomen revealed a large iliopsoas abscess extending from abdomen to upper part of thigh. Patient underwent percutaneous drainage of abscess and improved with anti-tuberculous drugs while continuing anti-retroviral therapy.
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