{Summary}
Key points
° Rabies is a neurotropic infection that is rare in Canada and almost always fatal once symptoms develop.
° Rabies postexposure prophylaxis is highly effective in preventing infection in exposed humans if administered promptly and before onset of rabies symptoms.
° Any direct human contact with a bat is an indication for rabies postexposure prophylaxis and should be discussed with the regional public health authority.
° No established efficacious therapies are available for treatment of rabies once symptom onset has occurred.
An immunocompetent 11-year-old boy presented with odynophagia and emesis to an urban hospital emergency department in Ontario, Canada. Seven days before presentation, he had developed progressive right-sided facial paresthesia and numbness, followed by anorexia and right-sided facial swelling. Four days after symptom onset, he had been prescribed oral valacyclovir (1 g, 3 times daily) at a local urgent care clinic for presumed Bell palsy secondary to herpes simplex virus; however, he was unable to tolerate this because of odynophagia. He had no history of allergies, sick contacts, tick bites, or recent travel outside the country.
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Source: Canadian Medical Association Journal, https://www.cmaj.ca/
Link: https://www.cmaj.ca/content/198/25/E969
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