Isolated Hydrophobia Presented as Furious Form Of Rabies

Abstract

Rabies is a zoonotic viral infection caused by Lyssavirus with incubation period ranging between one week to one year. However, incubation period of at least 20 years were reported. We report a case of isolated hydrophobia which became a fatal case of rabies. A 39-year-old foreign male, presented with abdominal pain, vomiting, whitish penile discharge, and reduced urine output. He was alert, cooperative, had left iliac fossa, left renal angle tenderness and febrile. Patient became agitated at the sight of the water and IV fluid bottle without displaying any neurologic symptoms. He denied recent animal bites. Treatment for probable Rabies meningoencephalitis was initiated and lumbar puncture was scheduled. However, he deteriorated, became incoherent, combative, and succumbed on the second day of admission. Postmortem of brain biopsy revealed meningoencephalitis with positive rabies qRT-PCR. Family members later confirmed the childhood dog bite however precise age and the treatment provided were unknown. Clinical diagnosis of Rabies is challenging without reliable history of contact with suspected or confirmed rabid animal, or presence of pathognomonic rabiesspecific signs of hydrophobia or aerophobia. Detection of human rabies cases can have implications on Post Exposure Prophylaxis (PEP) recommendations for victim’s close contacts who were exposed to infectious material. Possibility of rabies with prolonged incubation period should be considered by clinicians as misdiagnosis will significantly influence management practices.

International Journal of Human and Health Sciences Supplementary Issue 03: 2023 Page: S213