Encephalitis in a 54 year old woman after dog-bite

A 54 year old woman presented with a history of dyspnea, and vomiting since 2 day, and altered sensorium since 1 day. There was no history of seizures. Vitals were stable. At presentation, the patient was stuporous; however no focal neurologic deficits could be demonstrated and no next stiffness was present.

The patient was bitten by a rabid dog 13 days prior to presentation, on the forehead and scalp. Wound was washed with water immediately and equine anti rabies immunoglobulin was infiltrated around the wound. The patient received doses of rabies vaccine on days 0, 3, and 7.

Complete blood count, liver function tests and serum creatinine were normal. MR imaging of the brain showed no abnormality. A CSF analysis showed 233 cells/μl , with 95% lymphocytes, CSF glucose 64 mg/dl, and protein 71 mg/dl. HSV PCR of CSF was negative. PCR for rabies was positive in CSF.

The patient’s sensorium deteriorated over the course of the next 48 hours. The patient died on D5 of ICU stay due to intractable hypotension and arrhythmias

Rabies encephalitis after dog bite with rabies vaccine failure

Encephalitis in a pregnant woman

A 28 year old woman was admitted with a 1 day history of vomiting, seizures and altered sensorium. The patient was 30 weeks pregnant. Symptoms has started with 2 days of cough and coryza. No other family members were affected.

The patient was admitted to the intensive care unit, and required mechanical intubation due to poor sensorium. Vitals were stable. The patient was comatose (GCS 5), no signs of meningitis or focal neurologic deficits could be demonstrated.

Chest radiograph revealed diffuse infiltrates bilaterally. MRI brain was normal. The CSF analysis showed a lymphocyte dominant pleocytosis (cell count 84 cells/μl, 85% lymphocytes), CSF glucose 73 mg/dl and protein 46 mg/dl. HSV PCR of CSF was negative. H1N1 PCR on tracheal secretions was positive.

The patient underwent a spontaneous vaginal delivery after intrauterine fetal death on D2 of hospital stay. Ventilatory parameters and oxygenation improved over the next 10 days. However little improvement was seen with respect to neurological impairment.

H1N1 Influenza encephalitis and pneumonia in a pregnant woman