title: Unique clinical and imaging findings in a first ever documented PCR positive rabies survival patient: A case report.
abstract: BACKGROUND
  Rabies is fatal encephalitis which is a major public health problem in Asian and African countries. Till date, only 12 cases have been reported who have survived after rabies.
  
  
  METHODS
  In this communication we report a patient who is unique as the first documented long term rabies survivor with PCR positivity even after 4½ years of illness. Child sustained dog bite following which he received adequate prophylaxis. Within two weeks, child developed encephalopathy requiring evaluation. Child continues to have persistent myoclonic jerks, seizures, is dependent on all activities with severe neurological deficits. Nested reverse transcriptase PCR (RT-PCR) specific for rabies nucleoprotein gene in CSF and nuchal skin biopsy were positive for rabies viral RNA. The nuchal skin biopsy was also positive for rabies nucleoprotein antigen by fluorescent antibody test (FAT). We describe the clinical evolution and sequential MRI brain changes in this child.
  
  
  CONCLUSIONS
  Despite the uniformly dismal prognosis of human rabies, these unusual reports of survival of rabies patients may provide an impetus to explore newer therapeutic strategies for this otherwise fatal disease.
authors: Department of Neurology, National Institute of Mental health & Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: sundernetra@yahoo.co.in.
authors: Netravathi
authors: N
authors: M
authors: Department of Pediatrics and Neurology, Hinduja Hospital, Mumbai, India. Electronic address: vrajeshudani@yahoo.co.in.
authors: Udani
authors: U
authors: V
authors: Department of Neurovirology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 5600929, India. Electronic address: drreeta@gmail.com.
authors: Mani
authors: M
authors: Rs
authors: Department of Neurology, National Institute of Mental health & Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: veer.gadad@gmail.com.
authors: Gadad
authors: G
authors: V
authors: Department of Neurovirology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 5600929, India. Electronic address: dr.ashwinishetty@gmail.com.
authors: Ashwini
authors: A
authors: M A
authors: Department of Neurointervention and Neuroradiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: mayabhat05@yahoo.co.in.
authors: Bhat
authors: B
authors: M
authors: Department of Virology & Immunology, Haffkine Institute for Training, Research & Testing, Mumbai 400012, India. Electronic address: shrads.m@gmail.com.
authors: Mehta
authors: M
authors: S
authors: Department of Virology & Immunology, Haffkine Institute for Training, Research & Testing, Mumbai 400012, India. Electronic address: abhaychowdhary@yahoo.com.
authors: Chowdhary
authors: C
authors: A
authors: Department of Neurology, National Institute of Mental health & Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: pal.pramod@rediffmail.com.
authors: Pal
authors: P
authors: P K
authors: Department of Neurovirology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 5600929, India. Electronic address: mshampur@gmail.com.
authors: Madhusudana
authors: M
authors: S N
authors: Department of Neurology, National Institute of Mental health & Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: drpsatishchandra@yahoo.com.
authors: Satishchandra
authors: S
authors: P
mesh_terms: D000818:Animals; D001733:Bites and Stings; D001921:Brain / Q000473:pathology; D002415:Cats; D002648:Child; D004285:Dogs; D004569:Electroencephalography; D005071:Evoked Potentials; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D016133:Polymerase Chain Reaction; D011818:Rabies / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*; D011820:Rabies virus / Q000235:genetics*; D016896:Treatment Outcome
keywords: PCR positive rabies survivor; Rabies encephalopathy