Metagenomic Next-Generation Sequencing Unmasks Atypical Rabies - Guangxi Zhuang Autonomous Region, China, 2024.

What is already known about this topic?: Human rabies remains nearly universally fatal despite medical advances. Diagnosis is frequently delayed when patients present with atypical symptoms, and the failure to receive postexposure prophylaxis (PEP) continues to be a major contributor to mortality worldwide.

What is added by this report?: This represents the first confirmed human rabies case in Guangxi caused by the JSTZ190314 strain, successfully identified through metagenomic next-generation sequencing (mNGS). The patient initially presented with urinary symptoms that led to a misdiagnosis before characteristic neurological manifestations developed, ultimately progressing to brain death 28 days after neurological onset (34 days from initial urinary symptoms).

What are the implications for public health practice?: This case demonstrates the critical importance of mNGS in diagnosing atypical rabies presentations and emphasizes the urgent need for enhanced early clinical recognition, standardized PEP administration protocols, and strengthened regional viral surveillance systems.