Suspected Paralytic Rabies in an 8 Years 6 Months Old Boy Following Incomplete Post-Exposure Prophylaxis in Rural North Eastern Uganda: A Case Report.

BACKGROUND: Rabies is still a public health concern, especially in low resource settings with poor animal health management, stock out of rabies vaccine and immunoglobulin. Only 20% of patients present with paralytic rabies and it is at times difficult to distinguish from Guillain-Barre syndrome. In malaria endemic areas, rabies may have atypical presentation. Rabies encephalitis is almost always fatal. CASE PRESENTATION: We report an 8‑year‑and‑6‑month‑old African boy from Katakwi district in North Eastern Uganda who presented with headache, fever and waist pain followed by progressive lower‑limb weakness 28 days after a bite by a stray dog. There was no trauma, and he had no signs of meningeal irritation. He received anti-rabies vaccine on day 0.7 and 16 but did not get rabies immunoglobulin. He received supportive care including intravenous fluids and antibiotics at the hospital and died 7 days after the onset of symptoms. CONCLUSION: Paralytic rabies in children can be fatal even after vaccination, especially if rabies immunoglobulin is not given when there is a high risk exposure. There are also diagnostic challenges if there is an atypical presentation, particularly in children. Health system gaps around animal health can lead to preventable deaths from rabies.