Virology Case 2
Patient History
- Working on a roadside clean-up
crew
- Visual hallucinations
- Muscle Pains Vomiting
Vital Signs
- High Temp (37 C)
- High Pulse (116/min)
- Respiration ? (28/min)
- BP tass 168/104 mmHg
Patient Presentation
- Hypersthesia over the right side
of the body
- Agitated and less well oriented
- Developed hydrophobia
- Hypersalivation
- Wide fluctuations in body tem and
BP
Laboratory
- Normal blood work but with
increased lymphocytes with CSF
analysis
- Chest X ray is normal, and no
abnormal findings were found on
brain CT
- Nuchal skin biopsy tested positive
for neurotropic virus with DFA
test
- Saliva and skin tested positive
with RT-PCR
*Neorotropic – tends to attact the
nervous system
Rabies
- Findings of agitation and
hydrophobia are specific for
rabies encephalitis
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[NOTES]
Clinical Features
- Weakness at the bitten
extremities might be evident at
initial presentation
- Fluctuating consciousness
- Hydrophobia
- Inspiratory spasms
- Autonomic dysfunction
Pathogenesis and pathophysiology
- Transmission
o Infected saliva from a bite
of an infected animal
o Inhaling aerolised rabies
virus
o Tissue and organ
transplants
o Handling and skinning of
infected carcasses
o Contamination of an open
wound, scratch, abrasion,
or mucous membrane
- Viremia does not occur
- Incubation period phase can vary
from weeks to years but lasts 1-2
months on average

https://www.sciencedirect.com/science/
article/pii/S1474442213700383
------------------------------------------------------
Rabies
- Zoonotic from infected animals
like dogs, raccoons, skunks, bats,
and foxes
- Affects the central nervous
system
- Can be transmitted via non-bites
exposure and human to human
transmission
- Fatal
Clinical Diagnosis in Human
- First symptom is neuropathic pain
at the site of infections or wound
- Diagnosis can only be confirmed
by lab tests preferably conducted
post mortem on cns
- Tests are also performed on the
samples of saliva, serum and skin
biopsies of hair follicles at the
nape of the neck
https://link.springer.com/article/
10.1186/1743-422X-9-50
Alabata
Almagro
Ates
Bongcawil
Cadayday
Camanian
Catubay
Chavez
Llanera
Tabal
Vailoces
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[SCRIPT]
Case Presentation
A 31 year old man went to the ER of the
hospital with complaints fever and visual
hallucinations, muscle pains and
vomiting
Four days ago, he was already
experiencing back pains and malaise
while working for a roadside clean-up
On one hand, his vitals were abnormal
with high temperature, increased pulse
respiratory rate, and blood pressure
His physical examination shows that
there is an increasing sensation in his
forearm with hyperesthesia over the
entire right side of body, signs of
agitations, hydrophobia, and
hypersalivation.
Although his blood work was normal, an
analysis of his CSF shows significant
increase in lymphocytes. Also, his
biopsy shows Negri bodies
With these in mind, we have narrowed
down the possible viral agent and
disease

Viral agent and Disease

- First, it should be noted that the
patient is experiencing a viral
infection based on the significant
increase of lymphocytes in his
CSF analysis. According to
Keohane et al. (2019), increased
lymphocytes is often associated
with viral infections
- Going back to the patient
presentation, increased sensation
of an affected area such in the
case of the patient’s right forearm
are one of the first symptoms of
rabies according to Hemachudha
et al. (2013). Although there was
no animal bite, rabies can still be
transmitted via exposure of an
open wound to an infected saliva.
Probably, the patient had an open
wound and it got infected during
roadside clean up
- Meanwhile, references have
consistently associated
hydrophobia, agitation,
hypersalivation, and impaired
mental status with rabies
infections
- Lastly, there were Negri bodies
appearing in his biopsy, but it is
not specific to rabies, there are
cases that Negri bodies do
appear in histological
examinations according to CDC