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...

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Bibliographic Details
Published in:Journal of clinical virology 2013-06, Vol.57 (2), p.178-181
Main Authors: Deubelbeiss, A.N, Trachsel, Ch, Bachli, E.B, Kuffer, A, Budka, H, Eniseyskiy, P, Zimmermann, H, Wallace, R.M, Farley, S, Zanoni, R.G
Format: Article
Language:English
Subjects:
Adult
Allergy and Immunology
Animals
Antibodies, Viral - blood
Autopsy
Brain - immunology
Brain - virology
Clinical record
Coma - complications
Coma - diagnosis
Diagnosis
Encephalitis, Viral - complications
Encephalitis, Viral - diagnosis
Fatal Outcome
Human
Humans
Infectious Disease
Iraq
Male
Molecular Epidemiology
Phylogeny
Post-Exposure Prophylaxis
Rabies
Rabies - diagnosis
Rabies - epidemiology
Rabies - prevention & control
Rabies - virology
Rabies virus - genetics
Rabies virus - immunology
Rabies virus - isolation & purification
Switzerland
United Arab Emirates
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Summary: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).
ISSN:1386-6532
1873-5967
DOI:10.1016/j.jcv.2013.02.001