Soun Vince V, Eidson Millicent, Wallace Barbara J, Drabkin Peter D, Jones Ginelle, Leach Richard, Cantiello Kathy, Trimarchi Charles V, Qian Jiang
Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York, USA;
Int J Biomed Sci. 2006 Dec;2(4):434-45.
To help elucidate rabies disease patterns and control issues, a full assessment of a human case of dog-variant rabies was undertaken. In 2000, a 54-year-old man presented to a New York hospital with lower back discomfort four days after arrival from Africa. Rabies was first suspected 8 days after hospitalization 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 12(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 ensure early confirmation and triage of human contacts to reduce associated healthcare costs.
为了帮助阐明狂犬病的发病模式和防控问题，对一例犬传狂犬病病例进行了全面评估。2000年，一名54岁男子从非洲抵达美国后4天，因下背部不适前往纽约一家医院就诊。住院8天后，根据临床症状首次怀疑为狂犬病，当天采集了样本，次日确诊为狂犬病感染（对颈部皮肤活检样本进行荧光抗体检测）。发病后第12天，他失去意识，第15天停止了生命支持。随后，通过对从患者唾液中提取并扩增的狂犬病病毒RNA进行核酸序列分析，确认是非洲犬种变异株。对人类接触该患者的担忧进行管理，使得接受暴露后预防的人数为26人。由于美国不到一半的人类狂犬病病例在生前得到诊断，该病例强调了在任何不明原因脑炎的鉴别诊断中常规纳入狂犬病的必要性，以确保早期确诊并对人类接触者进行分类管理，从而降低相关医疗成本。
