A case of rabies in man: some problems in diagnosis and management.

A patient who returned from India with a gastrointestinal disturbance subsequently developed the clinical features of rabies. The diagnosis was confirmed by isolation of rabies virus from saliva and the demonstration of rising titres of rabies antibody. He was treated in an intensive care unit, ventilated mechanically, and given rabies antiserum, but cerebral activity ceased and he died after 22 days. His course was marked by numerous bouts of cardiac arrhythmia including complete heart block. This case indicates the need for vaccination against rabies to be carried out immediately after exposure to a possibly rabid dog since encephalitis develops a fatal outcome may not be prevented even with intensive medical treatment.