title: Imported human rabies in Switzerland, 2012: a diagnostic conundrum.
abstract: Human rabies is rare in Western Europe. It is not easily recognized in the absence of a history of exposure. We describe the clinical course, diagnosis and follow-up of an imported human rabies case in Switzerland. The patient, a U.S. citizen, presented at an outpatient clinic in Iraq with pain in his right shoulder on July 5, 2012. On July 8 he was transferred to a hospital in the United Arab Emirates, where he exhibited progressive encephalitis with coma. On July 29, he was transferred to a hospital in Switzerland, where he died on July 31, 2012. The autopsy showed severe encephalitis. Rabies was diagnosed by the rapid fluorescent focus inhibition test (RFFIT) and confirmed by fluorescence antibody testing (FAT) in brain smears and immunohistochemistry on paraffin-embedded brain sections. The viral strain was characterized by RT-PCR followed by sequencing and phylogenetic analysis as an American bat rabies strain associated with Tadarida brasiliensis. Close contacts and exposed health care workers received postexposure prophylaxis (PEP).
authors.affiliation: Institute of Veterinary Virology, Laenggass-Strasse 122, CH-3012 Berne, Switzerland.
authors.forename: A N
authors.initials: AN
authors.lastname: Deubelbeiss
authors.forename: Ch
authors.initials: Ch
authors.lastname: Trachsel
authors.forename: E B
authors.initials: EB
authors.lastname: Bachli
authors.forename: A
authors.initials: A
authors.lastname: Kuffer
authors.forename: H
authors.initials: H
authors.lastname: Budka
authors.forename: P
authors.initials: P
authors.lastname: Eniseyskiy
authors.forename: H
authors.initials: H
authors.lastname: Zimmermann
authors.forename: R M
authors.initials: RM
authors.lastname: Wallace
authors.forename: S
authors.initials: S
authors.lastname: Farley
authors.forename: R G
authors.initials: RG
authors.lastname: Zanoni
mesh_terms: D000328:Adult; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D001344:Autopsy; D001921:Brain / Q000276:immunology / Q000821:virology*; D003128:Coma / Q000150:complications / Q000175:diagnosis; D018792:Encephalitis, Viral / Q000150:complications / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D007493:Iraq; D008297:Male; D010802:Phylogeny; D056990:Post-Exposure Prophylaxis; D011818:Rabies / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D011820:Rabies virus / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification*; D013557:Switzerland; D014479:United Arab Emirates
chemical_list: D000914:Antibodies, Viral