Persistent mental symptoms and rabies.

Abstract

We read the case report by Wang and colleagues[1] with great interest. The authors linked persistent mental symptoms of the patient with rabies encephalitis. However, we think that the points listed below should be explained more clearly before this diagnosis can be confirmed. 1) The incubation period of rabies is only three days. It was not mentioned which body part was bitten by the dog. If the bite was close to the central nervous system, it would be especially important for development of rabies. We think that the bite could be a coincidental event unrelated to the subsequent mental symptoms. 2) Is there any knowledge about the dog’s last status? It is important to know whether the dog was rabid or not. 3) Which method was used to investigate rabies immunoglobulin in the cerebrospinal fluid? What were the patient’s other cerebrospinal fluid findings? For instance, was herpes simplex virus encephalitis investigated? This would be important to know because this is another possible explanation of the condition. 4) It is well known that rabies is almost always fatal, but this patient survived. Which factors might have resulted in the patient’s survival in the presence of severe persistent mental symptoms due to rabies encephalitis? Information on these points will help to clarify the probable cause of the mental symptoms in this patient.