Pathogenesis of rabies in a pregnant HIV immune-compromised woman in Zambia: A case report.

IF 0.8 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Journal of Public Health in Africa Pub Date : 2025-09-29 eCollection Date: 2025-01-01 DOI:10.4102/jphia.v16i1.1456
Martin Nyahoda, Mukatimui K Munalula, Agripa Lungu, Walter Muleya, Selia Ng'anjo, Willies Silwimba, Chrispin Mwando, Joyce N Shampile
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引用次数: 0

Abstract

Rabies is a fatal neglected tropical zoonotic disease caused by neurotropic viruses of the genus Lyssavirus in the family Rhabdoviridae. We report the disease progression in a 30-year-old woman, in her eighth pregnancy, living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART), who presented with neurological symptoms including aggression, restlessness, fever and vomiting 20 days following rabies exposure through multiple dog bites on the face and upper limbs. She had received a 4-dose regimen of rabies post-exposure prophylaxis (PEP), starting 2 days after exposure, with subsequent doses given 3 and 7 days later, while the 4th dose was administered 20 days after exposure. Wound washing was not performed, and rabies immunoglobulin was not administered as recommended by the World Health Organization for category 3 exposures. The disease rapidly progressed to rabies encephalitis, leading to death within 6 days of admission. Reverse transcriptase polymerase chain reaction (RT-PCR) performed on cerebral spinal fluid (n = 3) and nasopharyngeal swabs (n = 2) confirmed the diagnosis of rabies infection. Although the incubation period and symptomatology did not significantly deviate from documented classical cases, a compromised immunity evidenced by a low cluster of differentiation 4 (CD4) T-cell count of 382, coupled with non-adherence to recommended best practices for wound management and PEP administration, may have influenced the rapid disease progression. This case reveals the need for capacity building in health workers and the community to improve knowledge of rabies post-exposure response in Africa.

赞比亚一名艾滋病毒免疫受损孕妇狂犬病发病机制:一例报告。
狂犬病是由狂犬病毒科溶血病毒属嗜神经病毒引起的一种被忽视的致死性热带人畜共患疾病。我们报告了一名30岁妇女的疾病进展,在她的第八次怀孕,感染了人类免疫缺陷病毒(HIV),接受抗逆转录病毒治疗(ART),她在面部和上肢多处犬咬伤狂犬病暴露20天后出现神经系统症状,包括攻击性、躁动、发烧和呕吐。她接受了狂犬病暴露后预防(PEP)的4剂方案,从暴露后2天开始,在暴露后3天和7天后给予后续剂量,而在暴露后20天给予第四剂。没有进行伤口清洗,也没有按照世界卫生组织对第3类暴露的建议使用狂犬病免疫球蛋白。该病迅速发展为狂犬病脑炎,在入院后6天内死亡。脑脊液(n = 3)和鼻咽拭子(n = 2)逆转录聚合酶链反应(RT-PCR)证实狂犬病感染。虽然潜伏期和症状与文献记载的经典病例没有明显差异,但免疫功能受损(CD4 t细胞计数低至382),加上未遵守伤口处理和PEP的推荐最佳做法,可能影响了疾病的快速进展。这一病例表明,需要对非洲卫生工作者和社区进行能力建设,以提高对狂犬病暴露后应对的认识。
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来源期刊
Journal of Public Health in Africa
Journal of Public Health in Africa PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
自引率
0.00%
发文量
82
审稿时长
10 weeks
期刊介绍: The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.
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