Pediatric Rabies Due to a Feral Cat Bite in the Amazonas Region of Peru: First Rabies Case in a Decade

We report the first case of human rabies in a child from Amazonas after 10 years without an outbreak. An 8-year-old girl was admitted to the local hospital because of headache, myalgia, diarrhea, fever, and vomiting during the previous 4 days. Meningoencephalitis was suspected, and empiric therapy with ceftriaxone and vancomycin was started. However, in the following 3 days, she also presented progressive lower extremities weakness, behavioral changes, photophobia, irritability, sialorrhea, and hallucinations. Thus, she was transferred to our hospital. Phenytoin, dexamethasone, mannitol, and acyclovir were started, and ceftriaxone was continued. Five days later, the mother recalled that the patient was bitten by a feral cat. Thus, human rabies immunoglobulin serum was administered immediately. However, 2 days later, the patient died. Post-mortem brain direct immunofluorescence study confirmed human rabies. Awareness campaigns can be lifesaving since more than 99% of deaths can be prevented if timely treatment is provided.