Antemortem Diagnosis of New York Human Rabies Case and Review of U.S. Cases

A human case of imported dog-variant rabies is described and compared with previous cases to elucidate clinical patterns and methods to improve early confirmation and triage of human contacts to reduce associ ated health care costs. In 2000, a 54-year-old man presented to a New York hospital with lower back discomfort seven days after arrival from Africa. Rabies was first suspected 8 days after symptom onset based on clinical signs, specimens were collected on the same day, and rabies infection was confirmed the following day (fluorescence antibody testing on nuchal skin biopsy specimen). By the 13 th day after illness onset, he was unresponsive, and life support was removed on day 15. Subsequently, an African dog variant was confirmed by nucleic acid sequence analysis of rabies viral RNA extracted and amplified from the patient’s saliva. Management of human concerns about exposure to the patient kept the number of persons receiving postexposure prophylaxis to 26. With less than half of the U.S. human rabies cases being diagnosed antemortem, this case emphasizes the need to routinely include rabies in the differential diagnosis of any unexplained encephalitis to reduce potential human exposures, and for potential life-saving treatment if such treatments are developed and verified to be effective.