furious rabies after an atypical exposure愤怒的非典型暴露后狂犬病.pdfVIP

Learning Forum Furious Rabies after an Atypical Exposure Heiman F. L. Wertheim*, Thai Q. Nguyen, Kieu Anh T. Nguyen, Menno D. de Jong, Walter R. J. Taylor, Tan V. Le, Ha H. Nguyen, Hanh T. H. Nguyen, Jeremy Farrar, Peter Horby, Hien D. Nguyen C a s e D e s c r i p t i o n s atient 1. A 48-year-old male construction worker, with no preceding medical illnesses, was admitted to the Pintensive care unit of a hospital in Hanoi. For a few days prior to admission he experienced pain and numbness in both forearms and a flushed sensation throughout his body. He also reported increased perspiration and increased libido. At presentation, the patient was lucid but markedly agitated, and was unable to swallow due to involuntary inspiratory muscle spasms when he was presented with a glass of water (Video S1) or when he felt a breeze. On examination he was afebrile, and had a dry mouth, normal heart rate and blood pressure, and a Glasgow Coma Score of 15. He had no focal neurological signs and no neck stiffness, and Kernig’s sign was negative. Neither the patient nor his wife recalled that he had been bitten by a dog, cat, bat, or other mammal doi:10.1371/journal.pmed.1000044.g001 in the preceding months, and his skin showed no evidence of Figure 1: Dog Meat for Consumption for Sale at a Market in Hanoi, recent bite injuries or cuts. Viet Nam Patient 2. A 37-year-old male farmer, without any prior medical history, presented himself to a Hanoi outpatient [1]. Neither patient had been vaccinated recently, ruling clinic with increased perspiration, intermittent muscle spasms out post-vaccinal encephalomyelitis (acute disseminated of both legs, and the inability to drink normally due to