Patient 1
A 65-year-old man residing in a rural town of Tintane, southern
Mauritania, consulted at the Kiffa Hospital Center on December 2, 2018,
for hiccups and hydrophobia. Recent past history of the patient
suggested no significant medical problem, except for a scar from a bite
by a stray dog on the palm of the right hand that occurred on October
9, 2018. Immediately after the bite, the patient washed the wound with
soapy water and did not seek any medical treatment. Two months later, on
December 02, 2018, he started complaining of headache, fever, and
hiccups which required consultation at the health center of Tintane. The
symptomatic treatment he received did not have any effect on his
symptoms. Faced with the appearance of anxiety and agitation, the
patient was referred to the Kiffa Hospital Center, a regional tertiary
hospital. On admission, the patient was agitated and had hydrophobia,
pharyngeal spasms, muscle contracture, and sialorrhea since 24 hours.
The values for routine clinical laboratory tests, including hematology
and blood chemistry, were within normal range. The diagnosis of rabies
encephalitis was made on the basis of the typical clinical presentation.
A laboratory confirmation of rabies was not performed due to a lack of
technical facilities in the country. A symptomatic treatment based on
phenobarbital, diazepam, and paracetamol was administered without
success. The patient died a few hours after admission to the hospital.
The investigation around the case revealed two additional undeclared
human rabies cases in the town where the deceased patient came from,
possibly due to bites of the same rabid stray dog.