title: Antemortem diagnosis of human rabies in a veterinarian infected when handling a herbivore in Minas Gerais, Brazil.
abstract: The Ministry of Health's National Human Rabies Control Program advocates pre-exposure prophylaxis (PEP) for professionals involved with animals that are at risk of contracting rabies. We report an antemortem and postmortem diagnosis of rabies in a veterinarian who became infected when handling herbivores with rabies. The antemortem diagnosis was carried out with a saliva sample and a biopsy of hair follicles using molecular biology techniques, while the postmortem diagnosis used a brain sample and conventional techniques. The veterinarian had collected samples to diagnose rabies in suspect herbivores (bovines and caprines) that were subsequently confirmed to be positive in laboratory tests. After onset of classic rabies symptoms, saliva and hair follicles were collected and used for antemortem diagnostic tests and found to be positive by RT-PCR. Genetic sequencing showed that the infection was caused by variant 3 (Desmodus rotundus), a finding confirmed by tests on the brain sample. It is essential that professionals who are at risk of infection by the rabies virus undergo pre-exposure prophylaxis. This study also confirms that molecular biology techniques were used successfully for antemortem diagnosis and therefore not only allow therapeutic methods to be developed, but also enable the source of infection in human rabies cases to be identified accurately and quickly.
authors.affiliation: SES Health Surveillance Department/MG, Belo Horizonte, Av. Afonso Pena 2300, B. Funcionários, 30130-007 Belo Horizonte, MG, Brazil.
authors.forename: Mariana Gontijo de
authors.initials: MG
authors.lastname: Brito
authors.forename: Talita Leal
authors.initials: TL
authors.lastname: Chamone
authors.forename: Fernando José
authors.initials: FJ
authors.lastname: da Silva
authors.forename: Marcelo Yohito
authors.initials: MY
authors.lastname: Wada
authors.forename: Alexandre Braga de
authors.initials: AB
authors.lastname: Miranda
authors.forename: Juliana Galera
authors.initials: JG
authors.lastname: Castilho
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Carrieri
authors.forename: Ivanete
authors.initials: I
authors.lastname: Kotait
authors.forename: Francisco Leopoldo
authors.initials: FL
authors.lastname: Lemos
mesh_terms: D000328:Adult; D000818:Animals; D001921:Brain / Q000821:virology*; D002417:Cattle; D017809:Fatal Outcome; D006041:Goats; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis*; D011818:Rabies / Q000175:diagnosis* / Q000635:transmission; D011820:Rabies virus / Q000235:genetics / Q000276:immunology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012463:Saliva / Q000821:virology*; D018634:Veterinarians