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9-20_11_AM_Rhabdo_rota - Rhabdoviruses and reoviruses...

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Rhabdoviruses and reoviruses Rabies and rotavirus
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Rhabdoviruses Rabies
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Case presentation On October 5, 2009, a previously healthy man from Indiana aged 43 years visited  an employee health clinic with fever and cough. His vital signs and physical examination were  unremarkable except for coarse rales on lung auscultation. The clinician made a diagnosis of  bronchitis, prescribed antibiotics, and asked the patient to return the following day. At this  follow-up appointment, the patient reported worsening fever and chills, as well as new chest  pain and left arm numbness; he also exhibited decreased grip strength of the left hand. An  electrocardiogram showed no evidence of cardiac ischemia. Later that day, an evaluation at a  local emergency department was similarly unrevealing, and the patient was given narcotics  and muscle relaxants for presumed musculoskeletal pain and discharged home. On October 7, the patient returned to the same ED, where he was noted to have  akathisia and motor restlessness thought to be side effects from the muscle relaxant. The ED  physician advised admission to the hospital, but the patient returned home. Upon follow-up the  next day with a primary-care physician, the patient had prominent muscle fasciculations, fever,  tachycardia, and hypotension. Given these signs, the physician was concerned about the  possibility of sepsis and admitted him to the hospital. After admission, the patient's mental status deteriorated rapidly, and he underwent  endotracheal intubation for airway protection. On October 9, he was transferred to a referral  hospital in the neighboring state of Kentucky. A lumbar puncture yielded cerebrospinal fluid  (CSF) with glucose of 72 mg/dL (normal: 40--70 mg/dL), protein 140 mg/dL (normal: 15--45  mg/dL), 3 red blood cells/mm3 (normal: 0--2 cells/mm3), and 38 white blood cells /mm3  (normal: 0--5 cells/mm3); differential showed 99% lymphocytes and 1% monocytes. During  October 9--19, no etiology for the patient's disease was identified, and his hospital course  became complicated by bradycardia, hypotension, rhabdomyolysis, and renal failure requiring  hemodialysis. Results of a magnetic resonance image of the brain and a brain perfusion study  were normal. Bacterial and fungal cultures of CSF, in addition to laboratory tests for West Nile  virus, herpes simplex virus, influenza, and human immunodeficiency virus, were negative.
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