PANAJI: A 48-year-old man from Karnataka working in Goa was diagnosed with rabies 25 years after the dog bite he received, Annals of
Indian Academy of Neurology has reported in its latest issue. The unusual case has been recorded at the Goa Medical College (GMC) and hospital, Bambolim.
The patient was admitted to GMC in November 2009 and was reported to have been bitten by a dog at the age of 23. He had not received medical attention at that time.
The publication states that in cases around the world incubation periods of 14 to 19 years have been reported between the dog bite and the manifestation of symptoms of rabies. It could, however, not be established for definite that in this case there was no subsequent exposure to a dog, such as by way of licking etc.
The man was admitted to GMC with a history of fear of water and air.
He gave a definite history of dog bite on the leg 25 years ago and no other contact with known rabid canine subsequently. He could not provide history of vaccination or medical attention at that time. During the clinical examination, he was anxious and scared at the sight of water, flow of air under a fan, as noted by the medical residents and consultants, the study states.
Two days after admission in GMC, the patient's phobia seemed to have reduced, as he suddenly went to the bathroom to wash his face and drank a glass of water as well. He was reported to be conscious, alert and well-oriented to time and space. This cast doubts on the diagnosis even though the features of hydrophobia and photophobia suggested rabies encephalitis.
"He was then referred to the
general hospital for further management. However, he went to a private hospital in the zone. Within a few hours, he succumbed. Following the allegation of medical negligence by the guardian because of sudden deterioration and death, the body was shifted to the forensics department at Goa Medical College to establish the cause of death," the study states. The forensic report established the definitive diagnosis of rabies encephalitis.
The journal states that rabies accounts for over 20,000 deaths in India and that the disease can be easily mistaken in the early stages to be other conditions and often has to be established through a postmortem after death.
Explaining the prolonged incubation period in the case reported in Goa, the study states, "In rabies, the incubation period (the interval between exposure and the first symptom) is more variable than any other acute infection. During the incubation period, it is suggested that the virus is probably sequestered in the skeletal muscle at the site of bite, while the exposed person remains asymptomatic."
The study notes that the man came to Goa in search of a livelihood 25 years ago and lived in a semi-urban area of the state. He was employed to deliver milk in nearby areas and residents of the colony reported that he suffered a dog bite at this stage. Residents said the victim was a lover of dogs and would caress dogs. At the same time that he suffered the dog bite, the carcasses of two dogs were lifted from the area, residents remembered.
"I was also part of the team that conducted the postmortem following the death. We had also sent some samples to Bangalore for testing and it was confirmed to be a case of rabies. The male patient was residing in and around
Dona Paula and was seen to be suffering from hydrophobia. For an incubation period of close to 25 years, it's a highly unusual case," said Dr R G W Pinto, head of the department of pathology at GMC and one of the authors of the study. The other authors are Dr S K Shankar, Dr Anita Mahadevan, Dr Silvano Dias Sapeco, Dr M S G Ghodkirekar and Dr S N Madhusdana.