title: Phylogenetic and epidemiologic evidence of multiyear incubation in human rabies.
abstract: Eight years after emigrating from Brazil, an otherwise healthy man developed rabies. An exposure prior to immigration was reported. Genetic analysis revealed a canine rabies virus variant found only in the patient's home country, and the patient had not traveled internationally since immigrating to the United States. We describe how epidemiological, phylogenetic, and viral sequencing data provided confirmation that rabies encephalomyelitis may present after a long, multiyear incubation period, a consideration that previously has been hypothesized without the ability to exclude a more recent exposure. Accordingly, rabies should be considered in the diagnosis of any acute encephalitis, myelitis, or encephalomyelitis.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: Torrey A
authors.initials: TA
authors.lastname: Boland
authors.forename: Declan
authors.initials: D
authors.lastname: McGuone
authors.forename: Jenelle
authors.initials: J
authors.lastname: Jindal
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rocha
authors.forename: Melissa
authors.initials: M
authors.lastname: Cumming
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rupprecht
authors.forename: Taciana Fernandes Souza
authors.initials: TF
authors.lastname: Barbosa
authors.forename: Rafael
authors.initials: R
authors.lastname: de Novaes Oliveira
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Chu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.forename: Ivanete
authors.initials: I
authors.lastname: Kotait
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Kuzmina
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Yager
authors.forename: Ivan V
authors.initials: IV
authors.lastname: Kuzmin
authors.forename: E Tessa
authors.initials: ET
authors.lastname: Hedley-Whyte
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Brown
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000818:Animals; D001938:Brazil; D004285:Dogs; D054242:Emigrants and Immigrants; D006801:Humans; D055256:Infectious Disease Incubation Period; D008297:Male; D010802:Phylogeny; D011818:Rabies / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D013997:Time Factors; D014481:United States
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