Atypical paralytic rabies — A case-study from Kerala, India

Case Report

Author Details : Lakshmi G G*, Minu Mohan, Geethu John, Anish T S

Volume : 7, Issue : 2, Year : 2021

Article Page : 131-136

Suggest article by email


Introduction: Rabies, though endemic in India, has been a disease of low public health priority throughout the years. Being a non-notifiable disease together with limited diagnostic facilities, it often ends up in under-reporting of cases, especially atypical rabies. Failure of complete rabies Post Exposure Prophylaxis (PEP) with Immunoglobulin has been rarely reported.
Case: We report a case of atypical rabies in a 60-year-old man from a rural village in Kerala, who presented with fever, paralysis of limbs, fluctuating consciousness, phonophobia and without classical signs of hydrophobia and aerophobia 22 days after dog bite. The case is supplemented with supportive Magnetic Resonance Imaging (MRI) findings and corneal imprint smear Fluorescent Antibody Test (FAT). The death of the patient on the 28th day of exposure despite early PEP with rabies vaccine and immunoglobulin is suggestive of PEP failure.
Conclusion: The case study stresses on the need in making rabies a notifiable disease in the study setting, encouraging disease specific investigation, ensuring availability of vaccine and immunoglobulins with adherence to standardized treatment protocols.
Key Messages: Deviations from the recommended protocol for Animal bite management, such as delay in seeking PEP, lack of or improper administration of rabies immunoglobulin (e.g. missing out bite sites), lack of or improper primary wound care, and/or poor-quality rabies vaccine, may lead to death.

Keywords: Atypical rabies, Death, Post exposure prophylaxis failure, Zoonosis

How to cite : Lakshmi G G, Mohan M , John G , Anish T S, Atypical paralytic rabies — A case-study from Kerala, India. J Prev Med Holist Health 2021;7(2):131-136

Copyright © 2021 by author(s) and J Prev Med Holist Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (

Article History

Received : 07-05-2021

Accepted : 16-08-2021

Available online : 22-12-2021

View Article

PDF File   Full Text Article

Copyright permission

Get article permission for commercial use


PDF File   XML File   ePub File

Digital Object Identifier (DOI)

Article DOI

Article Metrics

Article Access statistics

Viewed: 269

PDF Downloaded: 56

Open Abstract (Increase article citation) Wiki in hindi