{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:56:35Z","timestamp":1790726195684,"version":"4.1.0"},"reference-count":62,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,21]]},"abstract":"<jats:p>Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinical features of rabies encephalopathy are highly nonspecific at the onset and clinicians from low endemic areas usually face difficulties in recognizing cases during the early stages. The need for establishing a rapid and accurate test to identify rabies during the ante-mortem period is important. However, in actual clinical practice, the latter may remain difficult for various reasons. In human rabies, positively identifying the antigen, antibody or genetic material by various diagnostic methods during the symptomatic period is affected by the unpredictable nature of viremia, levels of antibody immune response of the host, and the virulence of the infecting strain. Also, more advanced testing with greater sensitivity may not be readily available at all centers. Here we describe a case of a young male who was bitten by a rabid dog and developed progressive encephalopathy with a fatal outcome, with negative antibodies in the cerebrospinal fluid (CSF). A review of the literature on the clinical features, diagnostic tests, treatment and prevention of rabies is also presented.<\/jats:p>","DOI":"10.5339\/qmj.2016.15","type":"journal-article","created":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T06:19:39Z","timestamp":1494915579000},"source":"Crossref","is-referenced-by-count":7,"title":["Diagnostic difficulties in human rabies: A case report and review of the literature"],"prefix":"10.5339","volume":"2016","author":[{"given":"Kadavil","family":"Chacko","sequence":"first","affiliation":[{"name":"1Infectious Diseases Division, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh Theeyancheri","family":"Parakadavathu","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Division, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Al-Maslamani","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Division, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun P","family":"Nair","sequence":"additional","affiliation":[{"name":"1Infectious Diseases Division, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrutha Puthalalth","family":"Chekura","sequence":"additional","affiliation":[{"name":"2Department of Medicine, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Madhavan","sequence":"additional","affiliation":[{"name":"2Department of Medicine, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"key":"CIT0001"},{"issue":"7","key":"CIT0002","series-title":"Clin Infect Dis. Oxford University Press","first-page":"1085","article-title":"Antemortem diagnosis of human rabies","volume":"39","author":"Hemachudha\n\u00a0\nT","year":"2004"},{"key":"CIT0003","series-title":"Int J Infect Dis.","first-page":"99","article-title":"Rabies in Saudi Arabia: A need for epidemiological data","volume":"34","author":"Memish\n\u00a0\nZA","year":"2015"},{"issue":"7","key":"CIT0004","series-title":"PLoS Negl Trop Dis.","first-page":"e0003942","article-title":"Natural rabies infection in a Domestic Fowl (Gallus domesticus): A Report from India","volume":"9","author":"Baby\n\u00a0\nJ","year":"2015"},{"issue":"7","key":"CIT0005","series-title":"Int J Infect Dis.","first-page":"e495","article-title":"Clinical and epidemiological features of human rabies cases in the Philippines: A review from 1987 to 2006","volume":"15","author":"Dimaano\n\u00a0\nEM","year":"2011"},{"key":"CIT0006","series-title":"Harrison's Principles of Internal Medicine","article-title":"Rabies and other rhabdovirus infections","author":"Jackson\n\u00a0\nAC","year":"2015"},{"key":"CIT0007","series-title":"Int J Biomed Sci.","first-page":"434","article-title":"Antemortem diagnosis of New York human rabies case and review of U.S. Cases","volume":"2","author":"Soun\n\u00a0\nVV","year":"2006"},{"issue":"8","key":"CIT0008","series-title":"Jundishapur J Microbiol.","first-page":"e11671","article-title":"Severe abdominal pain as the first manifestation of rabies","volume":"7","author":"Ayatollahi\n\u00a0\nJ","year":"2014"},{"issue":"6017","key":"CIT0009","series-title":"Br Med J.","first-page":"1041","article-title":"A case of rabies in man: Some problems in diagnosis and management","volume":"1","author":"Cohen\n\u00a0\nSL","year":"1976"},{"key":"CIT0010","series-title":"Bull World Health Organ.","first-page":"579","article-title":"Fluorescent antibody staining of rabies virus antigens in the salivary glands of rabid animals","volume":"20","author":"Goldwasser\n\u00a0\nRA","year":"1959"},{"issue":"11","key":"CIT0011","series-title":"Clin Infect Dis.","first-page":"1410","article-title":"A reliable diagnosis of human rabies based on analysis of skin biopsy specimens","volume":"47","author":"Dacheux\n\u00a0\nL","year":"2008"},{"issue":"1","key":"CIT0012","series-title":"J Med Virol.","first-page":"150","article-title":"Case report: Rapid ante-mortem diagnosis of a human case of rabies imported into the UK from the Philippines","volume":"69","author":"Smith\n\u00a0\nJ","year":"2003"},{"key":"CIT0013","series-title":"Public Heal Rev.","first-page":"229","article-title":"Human rabies","volume":"3","author":"Maw\n\u00a0\nH","year":"1974"},{"key":"CIT0014","series-title":"The Natural History of Rabies","author":"Baer\n\u00a0\nGM","year":"1991"},{"issue":"1","key":"CIT0015","series-title":"J Clin Virol.","first-page":"17","article-title":"Ante mortem diagnosis of human rabies using saliva samples: Comparison of real time and conventional RT-PCR techniques","volume":"36","author":"Nagaraj\n\u00a0\nT","year":"2006"},{"issue":"6","key":"CIT0016","series-title":"Int J Infect Dis.","first-page":"339","article-title":"Rapid diagnosis of rabies in humans and animals by a dot blot enzyme immunoassay","volume":"8","author":"Madhusudana\n\u00a0\nSN","year":"2004"},{"issue":"2","key":"CIT0017","series-title":"Emerg Infect Dis.","first-page":"310","article-title":"Evaluation of a direct, rapid immunohistochemical test for rabies diagnosis","volume":"12","author":"Lembo\n\u00a0\nT","year":"2006"},{"issue":"3","key":"CIT0018","series-title":"Indian J Virol.","first-page":"392","article-title":"Evaluation of rt-PCR assay for routine laboratory diagnosis of rabies in post mortem brain samples from different species of animals","volume":"23","author":"Aravindh Babu\n\u00a0\nRP","year":"2012"},{"issue":"1","key":"CIT0019","series-title":"Electromyogr Clin 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rabies","volume":"353","author":"Hemachudha\n\u00a0\nT","year":"2005"},{"issue":"1","key":"CIT0024","series-title":"Antiviral Res.","first-page":"61","article-title":"Current and future approaches to the therapy of human rabies","volume":"99","author":"Jackson\n\u00a0\nAC","year":"2013"},{"issue":"4","key":"CIT0025","series-title":"Biomedica.","first-page":"474","article-title":"Evaluation of the seroconversion as a response to rabies vaccination in dogs, Valle del Cauca, Colombia","volume":"31","author":"P\u00e1ez\n\u00a0\nA","year":"2009"},{"issue":"RR-2","key":"CIT0026","series-title":"MMWR Recomm Rep.","first-page":"1","article-title":"Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the advisory committee on immunization practices","volume":"59","author":"Rupprecht\n\u00a0\nCE","year":"2010"},{"issue":"7","key":"CIT0027","series-title":"Hum Vaccin Immunother.","first-page":"1454","article-title":"Rabies pre-exposure vaccination of children with purified chick embryo cell vaccine (PCECV)","volume":"9","author":"Malerczyk\n\u00a0\nC","year":"2013"},{"issue":"7","key":"CIT0028","series-title":"M\u00e9decine Mal Infect.","first-page":"292","article-title":"Update on human rabies in a dog- and fox-rabies-free country","volume":"44","author":"Stahl\n\u00a0\nJ-P","year":"2014"},{"issue":"1","key":"CIT0029","series-title":"Hum Vaccin Immunother.","first-page":"177","article-title":"Safety of post-exposure rabies prophylaxis during pregnancy: A follow-up study from Guangzhou, China","volume":"9","author":"Huang\n\u00a0\nG","year":"2013"},{"issue":"5","key":"CIT0030","series-title":"Bull World Health Organ.","first-page":"693","article-title":"Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine","volume":"78","author":"Briggs\n\u00a0\nDJ","year":"2000"},{"issue":"8","key":"CIT0031","series-title":"Hum Vaccin Immunother.","first-page":"1077","article-title":"Evaluation of a 1-week intradermal regimen for rabies post-exposure prophylaxis: Results of a randomized, open label, active-controlled trial in healthy adult volunteers in India","volume":"8","author":"Sudarshan\n\u00a0\nMK","year":"2012"},{"key":"CIT0001"},{"issue":"7","key":"CIT0002","series-title":"Clin Infect Dis. 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rhabdovirus infections","author":"Jackson\n\u00a0\nAC","year":"2015"},{"key":"CIT0007","series-title":"Int J Biomed Sci.","first-page":"434","article-title":"Antemortem diagnosis of New York human rabies case and review of U.S. Cases","volume":"2","author":"Soun\n\u00a0\nVV","year":"2006"},{"issue":"8","key":"CIT0008","series-title":"Jundishapur J Microbiol.","first-page":"e11671","article-title":"Severe abdominal pain as the first manifestation of rabies","volume":"7","author":"Ayatollahi\n\u00a0\nJ","year":"2014"},{"issue":"6017","key":"CIT0009","series-title":"Br Med J.","first-page":"1041","article-title":"A case of rabies in man: Some problems in diagnosis and management","volume":"1","author":"Cohen\n\u00a0\nSL","year":"1976"},{"key":"CIT0010","series-title":"Bull World Health Organ.","first-page":"579","article-title":"Fluorescent antibody staining of rabies virus antigens in the salivary glands of rabid animals","volume":"20","author":"Goldwasser\n\u00a0\nRA","year":"1959"},{"issue":"11","key":"CIT0011","series-title":"Clin Infect Dis.","first-page":"1410","article-title":"A reliable diagnosis of human rabies based on analysis of skin biopsy specimens","volume":"47","author":"Dacheux\n\u00a0\nL","year":"2008"},{"issue":"1","key":"CIT0012","series-title":"J Med Virol.","first-page":"150","article-title":"Case report: Rapid ante-mortem diagnosis of a human case of rabies imported into the UK from the Philippines","volume":"69","author":"Smith\n\u00a0\nJ","year":"2003"},{"key":"CIT0013","series-title":"Public Heal Rev.","first-page":"229","article-title":"Human rabies","volume":"3","author":"Maw\n\u00a0\nH","year":"1974"},{"key":"CIT0014","series-title":"The Natural History of Rabies","author":"Baer\n\u00a0\nGM","year":"1991"},{"issue":"1","key":"CIT0015","series-title":"J Clin Virol.","first-page":"17","article-title":"Ante mortem diagnosis of human rabies using saliva samples: Comparison of real time and conventional RT-PCR techniques","volume":"36","author":"Nagaraj\n\u00a0\nT","year":"2006"},{"issue":"6","key":"CIT0016","series-title":"Int J Infect Dis.","first-page":"339","article-title":"Rapid diagnosis of rabies in humans and animals by a dot blot enzyme immunoassay","volume":"8","author":"Madhusudana\n\u00a0\nSN","year":"2004"},{"issue":"2","key":"CIT0017","series-title":"Emerg Infect Dis.","first-page":"310","article-title":"Evaluation of a direct, rapid immunohistochemical test for rabies diagnosis","volume":"12","author":"Lembo\n\u00a0\nT","year":"2006"},{"issue":"3","key":"CIT0018","series-title":"Indian J Virol.","first-page":"392","article-title":"Evaluation of rt-PCR assay for routine laboratory diagnosis of rabies in post mortem brain samples from different species of animals","volume":"23","author":"Aravindh Babu\n\u00a0\nRP","year":"2012"},{"issue":"1","key":"CIT0019","series-title":"Electromyogr Clin Neurophysiol.","first-page":"41","article-title":"A comparative study of Japanese and herpes simplex encephalitides","volume":"38","author":"Misra\n\u00a0\nUK","year":"1998"},{"issue":"6","key":"CIT0020","series-title":"Neurol India.","first-page":"662","article-title":"Paralytic rabies: MRI findings and review of literature","volume":"62","author":"Kalita\n\u00a0\nJ","year":"2014"},{"issue":"2","key":"CIT0021","series-title":"J Pediatr Neurosci.","first-page":"133","article-title":"Rabies encephalomyelitis vs. ADEM: Usefulness of MR imaging in differential diagnosis","volume":"7","author":"Santhoshkumar\n\u00a0\nA","year":"2012"},{"issue":"9413","key":"CIT0022","series-title":"Lancet.","first-page":"959","article-title":"Rabies and other lyssavirus diseases","volume":"363","author":"Warrell\n\u00a0\nMJ","year":"2004"},{"issue":"10","key":"CIT0023","series-title":"N Engl J Med.","first-page":"1068","article-title":"Survival after treatment of rabies","volume":"353","author":"Hemachudha\n\u00a0\nT","year":"2005"},{"issue":"1","key":"CIT0024","series-title":"Antiviral Res.","first-page":"61","article-title":"Current and future approaches to the therapy of human rabies","volume":"99","author":"Jackson\n\u00a0\nAC","year":"2013"},{"issue":"4","key":"CIT0025","series-title":"Biomedica.","first-page":"474","article-title":"Evaluation of the seroconversion as a response to rabies vaccination in dogs, Valle del Cauca, Colombia","volume":"31","author":"P\u00e1ez\n\u00a0\nA","year":"2009"},{"issue":"RR-2","key":"CIT0026","series-title":"MMWR Recomm Rep.","first-page":"1","article-title":"Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the advisory committee on immunization practices","volume":"59","author":"Rupprecht\n\u00a0\nCE","year":"2010"},{"issue":"7","key":"CIT0027","series-title":"Hum Vaccin Immunother.","first-page":"1454","article-title":"Rabies pre-exposure vaccination of children with purified chick embryo cell vaccine (PCECV)","volume":"9","author":"Malerczyk\n\u00a0\nC","year":"2013"},{"issue":"7","key":"CIT0028","series-title":"M\u00e9decine Mal Infect.","first-page":"292","article-title":"Update on human rabies in a dog- and fox-rabies-free country","volume":"44","author":"Stahl\n\u00a0\nJ-P","year":"2014"},{"issue":"1","key":"CIT0029","series-title":"Hum Vaccin Immunother.","first-page":"177","article-title":"Safety of post-exposure rabies prophylaxis during pregnancy: A follow-up study from Guangzhou, China","volume":"9","author":"Huang\n\u00a0\nG","year":"2013"},{"issue":"5","key":"CIT0030","series-title":"Bull World Health Organ.","first-page":"693","article-title":"Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine","volume":"78","author":"Briggs\n\u00a0\nDJ","year":"2000"},{"issue":"8","key":"CIT0031","series-title":"Hum Vaccin Immunother.","first-page":"1077","article-title":"Evaluation of a 1-week intradermal regimen for rabies post-exposure prophylaxis: Results of a randomized, open label, active-controlled trial in healthy adult volunteers in India","volume":"8","author":"Sudarshan\n\u00a0\nMK","year":"2012"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2016\/2\/article-15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2016\/2\/article-15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2016\/2\/article-15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:19:42Z","timestamp":1777310382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2016\/2\/article-15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,21]]},"references-count":62,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2016.15","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,21]]}}}