dr.a.jagadeesh institute of child health - cpachennai.com · slurring of speech and dysphagia-2...
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Dr.A.JagadeeshIMCU,Prof.JeyachandranInstitute of child health
}12 yr old boy presented with inability to use both lower limbs – 2 days
}Weakness in upper limbs-1 day
}Slurring of speech and
dysphagia -2 days
}h/o pain in all 4 limbs
}h/o fever (+)
}No h/o drooling of saliva,
diplopia, nasal regurgitation
}No h/o bowel or bladder
incontinence
}No h/o trauma ,loose stools
} H/o dogscratch (+) 11 months back
No h/o vaccination for dogscratch
}O/E conscious, oriented
} G/E – normal
} Vitals - stable
a.Higher functions- normal
b.Cranial nerves- normal
c.Motor system-
tone- decreased LL > UL
}Reflex – absent in both LL
sluggish in both UL
}Power – 0/5 in both LL
3/5 in both UL
2/5 in neck muscle
} Spine – normal
}Other systems – normal
} Routine investigations-Normal
Provisionally diagnosed as “Guillain
Barre Syndrome”
} Started on IV Ig.
}Developed hydrophobia and
aerophobia on the third day(corneal
smear –ve)
} In view of respiratory failure child
was intubated.
} Repeat corneal smear was positive for
rabies viral nucleocapsid protein by
Direct Fluorescent Antibody
} CSF sugar- 50 mg
protein-47, 1-2
degenerative cells
} Sedated with morphine and
midazolam and later ketamine
infusion.
} Started on Milwaukee rabies protocol
which includes
a.Vitamin C- 500 mg
b.T.Zinc 25 mg q8 hrly
c. L.carnitine 500 mg tds
} After 5 days of ventilatory support
child expired.
Tiny strip of brain
parenchyma infiltrated by
sparse inflammatory
cells with occasional
astrocytes
}Rabies is present in all
continents except antartica
}About 55000 cases of rabies
occurs across the globe per
year
}Between 30-60% 0f victims
are under the age of 15
}30% of cases present as
dumb rabies(paralytic)
}Rabies virus is a bullet
shaped,enveloped virus
}Transmission is through bite
or scratch from a rabid
mammal
} Incubation period:
10 days-3 months(upto 1 yr)
}Two forms
a.Furious or Encephalitic
b.Paralytic or Dumb
}Rabies specific antibody can
be detected in serum or CSF
}Rabies antigen is detected
through IFA in brain biopsy or
infected peripheral tissue
}Rabies is almost fatal
}6 reported cases of
survivors
}Milwaukee rabies protocol
}High index of suspicion is
needed in all cases of GBS.
}Repeated clinical examination
}Corneal smear is 100%
specific
Dr.Shanthi
Dr.Poovazhagi
Dr.Ezhilarasan
Dr.Sivaraman
M6 Unit
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