{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T23:42:10Z","timestamp":1771026130684,"version":"3.50.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Rabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100\/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T<jats:sub>10<\/jats:sub> level. He had hyperaesthesia below T<jats:sub>8<\/jats:sub>, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23\u00a0days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This case called for a serious evaluation of the country\u2019s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1186\/s40249-023-01148-2","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T05:01:42Z","timestamp":1697432502000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-8704","authenticated-orcid":false,"given":"Thinley","family":"Dorji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8208-9226","authenticated-orcid":false,"given":"Jeewanath","family":"Lamichaney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-3312","authenticated-orcid":false,"given":"Choeda","family":"Gyaltshen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3647-0130","authenticated-orcid":false,"given":"Lungten","family":"Lungten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guru Prasad","family":"Dhakal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2995-0486","authenticated-orcid":false,"given":"Sithar","family":"Dorjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-2847","authenticated-orcid":false,"given":"Mimi Lhamu","family":"Mynak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"1148_CR1","volume-title":"Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030. Geneva: World Health Organization; 2018."},{"key":"1148_CR2","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.ijid.2022.10.046","volume":"126","author":"H Gan","year":"2023","unstructured":"Gan H, Hou X, Wang Y, Xu G, Huang Z, Zhang T, et al. Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the Global Burden of Disease Study 2019. Int J Infect Dis. 2023;126:136\u201344. https:\/\/doi.org\/10.1016\/j.ijid.2022.10.046.","journal-title":"Int J Infect Dis"},{"key":"1148_CR3","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/S1474-4422(13)70038-3","volume":"12","author":"T Hemachudha","year":"2013","unstructured":"Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S, Laothamatas J. Human rabies: neuropathogenesis, diagnosis, and management. 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Thimphu: Ministry of Health, Royal Government of Bhutan; 2022."},{"key":"1148_CR6","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1016\/S0140-6736(22)02487-4","volume":"400","author":"SM Thumbi","year":"2022","unstructured":"Thumbi SM, Blumberg L, le Roux K, Salahuddin N, Abela B. A call to accelerate an end to human rabies deaths. Lancet. 2022;400:2261\u20134. https:\/\/doi.org\/10.1016\/S0140-6736(22)02487-4.","journal-title":"Lancet"},{"key":"1148_CR7","volume-title":"WHO Expert Consultation on Rabies","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. WHO Expert Consultation on Rabies. Geneva: World Health Organization; 2018."},{"key":"1148_CR8","doi-asserted-by":"publisher","first-page":"165","DOI":"10.4269\/ajtmh.18-0711","volume":"100","author":"RS Mani","year":"2019","unstructured":"Mani RS, Damodar T, Divyashree S, Domala S, Gurung B, Jadhav V, et al. Case reports: survival from rabies: case series from India. 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Accessed 29 Jul 2023."}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-023-01148-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40249-023-01148-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-023-01148-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:51:30Z","timestamp":1700527890000},"score":1,"resource":{"primary":{"URL":"https:\/\/idpjournal.biomedcentral.com\/articles\/10.1186\/s40249-023-01148-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["1148"],"URL":"https:\/\/doi.org\/10.1186\/s40249-023-01148-2","relation":{},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,16]]},"assertion":[{"value":"30 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was sought but was exempted from review by the Institutional Review Board, Khesar Gyalpo University of Medical Sciences of Bhutan via letter no IRB\/Waiver-Exempt\/PN-2023-013\/0159. Informed written consent was obtained from two of the patient\u2019s primary care givers.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed written consent obtained from patient\u2019s primary care givers. No information related to patient identity or photos leading to identification of the patient are presented.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"94"}}