Rabies. A second Australian case, with a long incubation period

The description of a second case of rabies in Australia, stressing the clinical features and that long incubation periods are possible.

A 10-year-old Vietnamese girl presented with fever, shoulder pain, subcutaneous emphysema, swallowing difficulty and agitation. After a period of maniacal behaviour all peripheral and central nervous system function was lost.

Despite maximal intensive care, the patient died. The diagnosis of rabies was made at autopsy.

Rabies occurs in Australia and needs to be considered in the differential diagnosis of acute encephalitis and/or the Guillain-Barré syndrome. Incubation periods of more than six years can occur.