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furious rabies after an atypical exposure愤怒的非典型暴露后狂犬病
Learning Forum
Furious Rabies after an Atypical Exposure
Heiman F. L. Wertheim*, Thai Q. Nguyen, Kieu Anh T. Nguyen, Menno D. de Jong, Walter R. J. Taylor, Tan V. Le, Ha H. Nguyen,
Hanh T. H. Nguyen, Jeremy Farrar, Peter Horby, Hien D. Nguyen
C a s e D e s c r i p t i o n s
atient 1. A 48-year-old male construction worker, with
no preceding medical illnesses, was admitted to the
Pintensive care unit of a hospital in Hanoi. For a few
days prior to admission he experienced pain and numbness
in both forearms and a flushed sensation throughout his
body. He also reported increased perspiration and increased
libido. At presentation, the patient was lucid but markedly
agitated, and was unable to swallow due to involuntary
inspiratory muscle spasms when he was presented with a glass
of water (Video S1) or when he felt a breeze. On examination
he was afebrile, and had a dry mouth, normal heart rate and
blood pressure, and a Glasgow Coma Score of 15. He had no
focal neurological signs and no neck stiffness, and Kernig’s
sign was negative. Neither the patient nor his wife recalled
that he had been bitten by a dog, cat, bat, or other mammal doi:10.1371/journal.pmed.1000044.g001
in the preceding months, and his skin showed no evidence of
Figure 1: Dog Meat for Consumption for Sale at a Market in Hanoi,
recent bite injuries or cuts. Viet Nam
Patient 2. A 37-year-old male farmer, without any prior
medical history, presented himself to a Hanoi outpatient [1]. Neither patient had been vaccinated recently, ruling
clinic with increased perspiration, intermittent muscle spasms out post-vaccinal encephalomyelitis (acute disseminated
of both legs, and the inability to drink normally due to
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