Rabies in Turkey: Three Human Cases Illustrating the Importance of Suspecting Exposure

Abstract

Rabies, a fatal encephalitis of viral origin, is still a major health problem in the developing world. It begins, after exposure, with centripetal spread of the virus through peripheral nerves to the central nervous system. The virus proliferates there and spreads to the tissues via peripheral nerves. The diagnosis is not difficult when a nonimmunized patient presents with hydrophobia after a bite by a known rabid animal. Failure to identify an exposure and administer postexposure prophylaxis, however, can lead to a fatal outcome. We report 3 fatal cases of rabies in which the risk of developing rabies had not been seriously considered. Two had apparent dog bites, but 1 had a minor abrasion. Because rabies is uniformly fatal, possible exposure should be seriously considered in patients with mammalian bites or scratches.

Discrepancies in Data Reporting for Rabies, Africa

“…Approximately 30% of human rabies cases develop in the paralytic or dumb form ( 8 ), and the overlap of symptoms with those of other infections often leads to misdiagnosis ( 9 – 12 ). Apart from misdiagnosis, rabies exposures are often ignored or deemed as minimal in dog rabies–endemic areas of the world.…”

Rabies epidemiology and control in Turkey: past and present

“…The Etlik Central Veterinary Control and Research Institute (ECVCRI) in Ankara acts as the national rabies reference centre and producer of a modified live attenuated rabies vaccine based on the Kelev virus for vaccination of dogs. Occasionally, histology and the detection of Negri bodies have been used to diagnose rabies in humans [8]. For molecular tests, particularly for ante-mortem diagnosis in humans, and for confirmation, samples must be transported to the ECVCRI where the standard diagnostic tests are complemented by virus isolation in cell culture and sensitive reverse-transcriptase polymerase chain reaction (RT–PCR).…”