Introduction:This study reports a confirmed case of human rabies diagnosed through metagenomic nextgeneration sequencing(mNGS).The patient was a 22-year-old female who developed symptoms 3 months after sustaining a sc...Introduction:This study reports a confirmed case of human rabies diagnosed through metagenomic nextgeneration sequencing(mNGS).The patient was a 22-year-old female who developed symptoms 3 months after sustaining a scratch on the upper lip from a domesticated dog,without receiving postexposure prophylaxis(PEP).She initially presented with urinary symptoms and was misdiagnosed with a urinary tract infection.Neurological symptoms subsequently emerged,prompting intensive life support interventions including mechanical ventilation,recombinant human interferon-α2b,ribavirin,norepinephrine,venoarterial extracorporeal membrane oxygenation(VAECMO),and continuous renal replacement therapy.Methods:Clinical data were collected from hospital records,including exposure history,symptoms,treatments,and outcomes.Saliva specimens were tested by reverse transcription polymerase chain reaction(RTPCR)and mNGS.Sequencing data were processed by standard bioinformatics pipelines,and phylogenetic analysis was performed with MAFFT alignment and IQ-TREE maximum-likelihood reconstruction.Results:Rabies virus infection was confirmed through reverse transcription polymerase chain reaction(RTPCR)and mNGS analysis of saliva samples.The detected strain,JSTZ190314,represents the first documented case of this genotype in Guangxi,China.Despite initial stabilization with ECMO support,the patient’s neurological condition deteriorated progressively,leading to brain death 28 days after neurological onset(34 days from initial urinary symptoms).Conclusion:mNGS proves invaluable as a diagnostic tool for atypical rabies presentations.Enhancing early clinical recognition capabilities,ensuring timely and standardized PEP implementation,and strengthening regional viral strain surveillance represent critical components for effective rabies prevention and control strategies.展开更多
基金Supported by the Specific Research Project of Guangxi for Research Bases and Talents(AD22035052).
文摘Introduction:This study reports a confirmed case of human rabies diagnosed through metagenomic nextgeneration sequencing(mNGS).The patient was a 22-year-old female who developed symptoms 3 months after sustaining a scratch on the upper lip from a domesticated dog,without receiving postexposure prophylaxis(PEP).She initially presented with urinary symptoms and was misdiagnosed with a urinary tract infection.Neurological symptoms subsequently emerged,prompting intensive life support interventions including mechanical ventilation,recombinant human interferon-α2b,ribavirin,norepinephrine,venoarterial extracorporeal membrane oxygenation(VAECMO),and continuous renal replacement therapy.Methods:Clinical data were collected from hospital records,including exposure history,symptoms,treatments,and outcomes.Saliva specimens were tested by reverse transcription polymerase chain reaction(RTPCR)and mNGS.Sequencing data were processed by standard bioinformatics pipelines,and phylogenetic analysis was performed with MAFFT alignment and IQ-TREE maximum-likelihood reconstruction.Results:Rabies virus infection was confirmed through reverse transcription polymerase chain reaction(RTPCR)and mNGS analysis of saliva samples.The detected strain,JSTZ190314,represents the first documented case of this genotype in Guangxi,China.Despite initial stabilization with ECMO support,the patient’s neurological condition deteriorated progressively,leading to brain death 28 days after neurological onset(34 days from initial urinary symptoms).Conclusion:mNGS proves invaluable as a diagnostic tool for atypical rabies presentations.Enhancing early clinical recognition capabilities,ensuring timely and standardized PEP implementation,and strengthening regional viral strain surveillance represent critical components for effective rabies prevention and control strategies.
