Case report: Rapid ante‐mortem diagnosis of a human case of rabies imported into the UK from the Philippines

Abstract

The United Kingdom is free from rabies, with the last human death from indigenous rabies recorded in 1902. However, between 1946 and 2000, 20 deaths were reported in the United Kingdom in people who were bitten and infected while abroad in rabies endemic areas. The rapid diagnosis of suspected human rabies cases influences the use of anti-rabies post-exposure prophylaxis for potential contacts with the victim. In addition, the occurrence of a human rabies case requires urgent investigation to support patient management policies. In May 2001, a case of human rabies imported into the United Kingdom from the Philippines was identified. A 55-year-old man was admitted to University College Hospital, London, with clinical symptoms and a history consistent with exposure to rabies. Saliva, cerebrospinal fluid), and skin biopsies (from the wound site and nape of the neck) were submitted for conventional ante-mortem diagnostic techniques. Established diagnostic techniques, including the fluorescent antibody test (FAT), mouse inoculation test, (MIT) and the rabies tissue culture inoculation test (RTCIT), failed to detect the virus. In contrast, hemi-nested reverse transcription-polymerase chain reaction (RT-PCR), followed by automated sequencing confirmed the presence of classical rabies virus (genotype 1) in both the saliva and skin specimens within 36 hr of sample submission. Subsequent phylogenetic analysis demonstrated that this isolate was closely related to that of canine variants currently circulating in the Philippines.

Comparative Analysis of Rabies Virus Reverse Transcription-PCR and Virus Isolation Using Samples from a Patient Infected with Rabies Virus

“…In this study we could demonstrate that detection of rabies viral RNA by RT-PCR was possible in intravitam as well as postmortem specimens with high sensitivity, supporting previous reports (1,13). RT-PCR might therefore be a feasible approach to support intravitam diagnosis of rabies in a timely fashion.…”

“…Confirmatory assays for DFA comprise the rabies tissue culture infection test (RTCIT) and mouse inoculation test (MIT) but require days (RTCIT) to weeks (MIT) until final diagnosis. In addition to these classical methods, reverse transcription (RT)-PCR and real-time RT-PCR, which can be accomplished in less than 6 to 8 h, have been developed and used in pilot studies (1,10,13,16). Although preliminary data suggest that sensitivity of RT-PCR seems to be higher than that of RTCIT or MIT, this issue has not been systematically analyzed with actual human rabies cases (3,6,16).…”

Molecular Epidemiology of Rabies Virus Isolates in India

“…An epidemiological marker of this kind would be more useful for the detection of human travel-related rabies acquired from countries where rabies is endemic. There has been an increase in the number of human travel-related cases of rabies contracted during travel to countries where rabies is endemic (19,34). Earlier, Smith et al (35) used the differential digestion of PCR-amplified products with restriction enzymes to trace the origin of rabies virus infection among immigrants to the United States.…”

Development of a Real-Time, TaqMan Reverse Transcription-PCR Assay for Detection and Differentiation of Lyssavirus Genotypes 1, 5, and 6

“…Genotypes 2 to 4 are widely distributed throughout Africa (18), whereas genotypes 5 and 6 are distributed throughout Europe (22). The United Kingdom is considered "rabies-free," with only occasional cases of human rabies arising from contact with rabid animals while abroad (15,24). However, in 1996 a positive case of EBLV type 2 was found in a Daubenton's bat (Myotis daubentonii) in Sussex (30).…”