- by Dr Gowher Pebbles n Pearl Pediatrics and Child Care
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- Apr 29 2017
A 12 year old boy in Chennai presented at a hospital with inability to use both limbs, slurring of speech and dysphagia since 2 days and weakness in both upper limbs since 1 day. On CNS examination higher functions and cranial nerves were normal although reflexes were absent in both lower limbs and sluggish in both upper limbs. Power was diminished in the neck muscles as well as both upper and lower limbs. A provisional diagnosis of Guillian - Barre Syndrome was made.
On the 3rd day the child developed hydrophobia and aerophobia. A corneal smear demonstrated presence of the rabies virus by direct fluorescent antibody testing. A history of being ‘scratched’ by a dog 11 months earlier was then elicited from the relatives but there was no history of rabies vaccine having been administered. The boy was put under heavy sedation and treatment was started based on the Milwaukee protocol. However after 5 days of ventilator support, the child expired. Post-mortem brain biopsy confirmed the diagnosis of rabies. In India, rabies kills about 20000 people each year
World Health Organisation (WHO): Recommends immediate vaccination even for nibbling of uncovered skin, minor scratches and abrasions without bleeding by an animal. Association for Prevention and Control of Rabies in India (APCRI): Bites from infected animals, licks on broken skin or mucous membrane or scratches, are the modes of transmission. Immediate Vaccination.
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