Suspected Paralytic Rabies in an 8 Years 6 Months Old Boy Following Incomplete Post-Exposure Prophylaxis in Rural...

Rabies is still a public health concern, especially in low resource settings with poor animal health management, stock out of rabies vaccine and immunoglobulin. Only 20% of patients present with paralytic rabies and it is at times difficult to distinguish from Guillain-Barre syndrome. In malaria endemic areas, rabies may have atypical presentation. Rabies encephalitis is almost always fatal.

We report an 8‑year‑and‑6‑month‑old African boy from Katakwi district in North Eastern Uganda who presented with headache, fever and waist pain followed by progressive lower‑limb weakness 28 days after a bite by a stray dog. There was no trauma, and he had no signs of meningeal irritation. He received anti-rabies vaccine on day 0.7 and 16 but did not get rabies immunoglobulin. He received supportive care including intravenous fluids and antibiotics at the hospital and died 7 days after the onset of symptoms.

Paralytic rabies in children can be fatal even after vaccination, especially if rabies immunoglobulin is not given when there is a high risk exposure. There are also diagnostic challenges if there is an atypical presentation, particularly in children. Health system gaps around animal health can lead to preventable deaths from rabies.