Rabies Virus

A 28-year-old male from rural Maharashtra presents to the emergency department with a 10-day history of fever, headache, and progressive behavioural changes. His wife reports he has become increasingly irritable and aggressive over the past 3 days. On examination, he is febrile (38.5°C), alert but agitated, with no focal neurological deficit. He has a history of a dog bite on his left forearm 6 weeks ago, which he did not seek treatment for. CSF analysis shows lymphocytic pleocytosis (120 cells/μL, 90% lymphocytes) with normal glucose and mildly elevated protein. Blood culture and routine bacterial cultures are negative. What is the most likely diagnosis?

A 28-year-old man from rural Maharashtra presents with fever, anxiety, and excessive salivation for 3 days. He recalls being bitten by a stray dog 6 weeks ago but did not seek medical attention. On examination, he shows hydrophobia and aerophobia. What is the most common animal source of rabies virus transmission in India?

A 28-year-old male farmer from rural Maharashtra presents to the emergency department with a 10-day history of fever, restlessness, and progressive neurological deterioration. He reports being bitten by a stray dog 6 weeks ago while working in the fields, but did not seek medical attention at that time. On examination, he is agitated, has excessive salivation, and exhibits hydrophobia—he refuses to drink water despite severe thirst. His temperature is 38.5°C, and he shows signs of autonomic instability with tachycardia (HR 110/min) and irregular respirations. CSF analysis shows lymphocytic pleocytosis with normal glucose and elevated protein. What is the most likely diagnosis?

A 35-year-old woman from Rajasthan is brought to the emergency department with a 5-day history of progressive encephalitis, fever, and behavioural changes following a bat bite 3 weeks ago. The clinical team suspects rabies. Which investigation would be most specific for confirming rabies virus infection in the prodromal-to-early encephalitic phase?

A 5-year-old boy from rural Uttar Pradesh is brought to the clinic 4 days after being bitten on the hand by a bat found in his home. The parents are concerned because the bite was not immediately visible and they only noticed it when the child developed a small wound with minimal bleeding. The child is otherwise well, afebrile, and has no neurological symptoms. What is the most appropriate management?