A case of rabies was recently diagnosed in Sweden. The patient, a 19 year old girl, spent some of her time in Sweden and some with her family in Thailand. In March 2000 (while in Thailand), one of the family’s dogs, a puppy, strayed for a day and returned with bite wounds. Several members of the family, but mainly the 19 year old girl, took care of the puppy, which died within two weeks. The girl had been in contact with the wounds of the dog, but it is unclear if she was actually bitten.
After returning to Sweden, the girl was referred to hospital in mid June with a urinary tract infection. An intravenous urogram was performed, venous access being obtained in her right arm. On June 20, three days later, she visited her doctor with paraesthesia in her right hand. The next day she had more severe paraesthesia in her right arm, was increasingly agitated, and developed ‘hydrophobia’. On June 22, she suffered a circulatory collapse and was put on mechanical ventilation. The patient died 19 days after the onset of symptoms.
Rabies virus was isolated from the patient’s saliva (collected on the ninth day after the onset of symptoms) in murine neuroblastoma cell cultures and its presence was confirmed by immunofluorescence the following day. Investigation by immunofluorescence of cell smears prepared from a hair follicle biopsy on day 6 was positive, but corneal imprints (day 9) were negative. Rabies virus antibodies could not be detected by rapid fluorescent focus inhibition test in serum collected on day 6, day 9, and day 13.
Sweden is free of rabies. Only one human case, a photographer bitten by a dog in India in 1974, has been diagnosed in Sweden in the past 50 years. As soon as the diagnosis was suspected, the rest of the family (also in Sweden at that time) was immunised against rabies. Although person to person transmission has not been documented, the hospital staff who had been in direct contact with the girl were, after discussion, also immunised.