Dilemma in managing human clinical rabies encephalitis in a developing country: a case report of a twelve year old girl from Paediatric department of a health facility in Yola, Adamawa state, North-Eastern Nigeria

Rabies is a viral infection of the central nervous system, contracted from the bite of an infected animal, and is nearly always fatal without proper post exposure prophylaxis. Our patient, a 12 year old girl who was bitten by a stray wild dog two month before the onset of a progressive encephalopathy, which began with fever temperature (38.3◦C), vomiting, irrational talks, diaphoresis, restlessness, gradual inability to talk, obtunded and altered sensorium. Dirty wound was observed on the site of dog bite; cerobrospinal fluid chemistry showed raised protien (113mg/dl) and glucose (6.6mmol/l). Rabies virologic and serologic testing was not performed due to lack of facilities. She was suctioned regularly, placed on antibiotic, nasogastric tube feeding, anti tetanus serum and anti rabies vaccine. Human rabies immune globulin, (HRIG) was not available for use and she was subsequently discharged against medical advice.