Rabies: A second Australian case, with a long incubation period

Objective: The description of a second case of rabies in Australia, stressing the clinical features and that long incubation periods are possible. Clinical features: A 10-year-old Vietnamese girl presented with fever, shoulder pain, subcutaneous emphysema, swallowing difficulty and agitation. After a period of maniacal behaviour all peripheral and central nervous system function was lost. Intervention and outcome: Despite maximal intensive care the patient died. The diagnosis of rabies was made at autopsy. Conclusions: Rabies occurs in Australia and needs to be considered in the differential diagnosis of acute encephalitis and/or the Guillain-Barre syndrome. Incubation periods of more than six years can occur.