Difficulties in diagnosing rabies using the example of a clinical case in the Omsk region

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Abstract

Rabies is the deadliest zoonotic disease caused by the rabies virus, a member of the genus Lyssavirus. The disease occurs after a bite from a wild or domestic animal.

The paper presents a clinical case of rabies with early diagnostic difficulties, particularlyclinical, epidemiological, and laboratory diagnostic features, in a patient suffering from alcoholism. The victim sought medical help 20 days after the dog bite. On day 29, a hydrophobia clinic was observed. The patient exhibited signs of visual and auditory hallucinations, aggressiveness, and disorientation in place and time, which resembled the development of alcoholic psychosis. Saliva samples were collected on day 3 of the disease, and its polymerase chain reaction test was negative for rabies virus. On day 29, the patient died. The diagnosis of rabies was confirmed antemortem and posthumously. The virus was detected in the saliva on day 9 of the disease and posthumously in the cerebral cortex, medulla oblongata, cerebellum, and salivary glands. Histologically, Babesh–Negri bodies were found in the brain tissue. Necessary preventive measures were implemented.

The unfavorable outcome in the described case of rabies emphasizes the lack of awareness of the population (especially rural) about the risk of contracting rabies infection through contact with animals and the importance of timely post-exposure prophylaxis. Timely anti-rabies care remains the only effective means of preventing related deaths.

About the authors

Larisa V. Puzyreva

Omsk State Medical University; Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: puzirevalv@mail.ru
ORCID iD: 0000-0003-0495-3645
SPIN-code: 8647-3727

MD, Dr. Sci. (Medicine)

Russian Federation, Omsk; Omsk

Elena M. Poleshchuk

Omsk Research Institute of Natural Focal Infections

Email: e-poleschuk@yandex.ru
ORCID iD: 0000-0002-8217-5159
SPIN-code: 5820-0815

Cand. Sci. (Biology)

Russian Federation, Omsk

Nina V. Bardina

Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: nina.bardina.1974@mail.ru

MD

Russian Federation, Omsk

Olga V. Vasilyeva

City Clinical Hospital No. 11

Email: ovomsk55@mail.ru
ORCID iD: 0000-0002-7489-3089
SPIN-code: 3327-8337

MD, Cand. Sci. (Medicine)

Russian Federation, Omsk

Gennady N. Sidorov

Omsk Research Institute of Natural Focal Infections; Omsk State Pedagogical University

Email: g.n.sidorov@mail.ru
ORCID iD: 0000-0002-8344-7726
SPIN-code: 7426-2435

Dr. Sci. (Biology), Professor

Russian Federation, Omsk; Omsk

Marina A. Sergunova

Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: savkina_es@oniipi.org

MD

Russian Federation, Omsk

Inna M. Tolokh

Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: inna.tolox@mail.ru
ORCID iD: 0000-0002-3828-3750
Russian Federation, Omsk

Tatyana G. Semenova

Clinical Psychiatric Hospital named after N.N. Solodnikov

Email: savkina_es@oniipi.org
ORCID iD: 0000-0001-8024-5021
Russian Federation, Omsk

Ekaterina S. Savkina

Omsk Research Institute of Natural Focal Infections

Author for correspondence.
Email: savkina_es@oniipi.org
ORCID iD: 0000-0002-4434-1734
SPIN-code: 5268-1588
Russian Federation, Omsk

Daria N. Tagakova

Omsk State Medical University; Omsk Research Institute of Natural Focal Infections

Email: tagakova_dn@oniipi.org
ORCID iD: 0000-0001-9890-1031
SPIN-code: 3117-8039
Russian Federation, Omsk; Omsk

Yulia V. Bukareva

Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: bukareva.j@mail.ru

MD

Russian Federation, Omsk

Irina A. Sheveleva

Infectious Diseases Clinical Hospital No. 1 named after D.M. Dolmatov

Email: irenashev55@mail.ru

MD

Russian Federation, Omsk

Olga V. Petrovskaya

Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Omsk Region

Email: oso@55.rospotrebnadzor.ru
Russian Federation, Omsk

Yuri A. Pnevsky

Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Omsk Region

Email: oso@55.rospotrebnadzor.ru
Russian Federation, Omsk

Marina G. Tkacheva

Kolosovskaya Central District Hospital

Email: savkina_es@oniipi.org
Russian Federation, Omsk

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2. Fig. 1. Photographs of histological material: a — diffuse microgliosis of cerebral tissue, productive vasculitis (coloring according to Turevich, ×100); b — spinal cord, productive vasculitis, perivascular edema (hematoxylin and eosin staining, ×100); c — basophil granules in the cytoplasm of neurons (coloring according to Turevich, ×100); d — erythrocyte thrombus in a vessel of the pia mater, swelling of cerebral tissue, granularity of the cytoplasm of neurons (hematoxylin and eosin staining, ×100); e — productive vasculitis, diffuse microgliosis of cerebral tissue (hematoxylin and eosin staining, ×100); f — granular cytoplasm of spinal cord neurons (coloring according to Turevich, ×100).

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