Neurological recovery with serological response in a rabies survivor on long-term follow-up

Abstract

An 18-year-old girl presented with headache, vomiting, dysarthria, diplopia and ataxia following a stray dog bite 20 days prior to presentation. The dog was killed by her neighbours. She received three doses of anti-rabies vaccine and one dose of rabies immunoglobulin (RVIG) before presentation. Diagnosis of rabies was confirmed based on four-fold rise in serum and CSF rabies virus neutralizing antibodies (RVNA) by rapid fluorescent focus inhibition test (RFFIT) titres coupled with history of dog-bite and a normal MRI. With supportive care and empirical administration of IVIG her condition improved over months and at her final visit to hospital at five years, she was physically independent with mild persistent dysarthria. Ours is one of the longest followed cases of rabies survivor in whom we had used IVIG empirically and could demonstrate the decline in the RVNA level in CSF and verify the steady neurological recovery over five years.

Recent updates on laboratory diagnosis of rabies

“…In the last decade, a protracted clinical course and longer survival in some rabies cases were witnessed which can be attributed to factors such as prior partial or complete rabies vaccination, increased awareness about rabies, improved access to medical care in India 6 15 16 17 18 19 20 22 23 , ante-mortem laboratory confirmation and effective intensive care and supportive treatment 19 . While most survivors experienced moderate-to-severe neurological sequelae, a few cases from India and elsewhere have shown almost complete recovery with minimal sequelae 18 22 23 24 . Such rare cases with favourable outcomes have renewed hope and sparked interest in exploring aggressive management and experimental protocols among physicians and family members of individuals affected by this devastating disease.…”