What’s Your Diagnosis? Suspected Rabies Exposure in the ED

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Management of Acute Urinary Retention in the Emergency Department right.

Case Presentation: Management of Suspected Rabies Exposure in the Emergency Department

A 35-year-old woman presents to the ED for vaccinations prior to a 3-month adventure trip to Southeast Asia…

  • She said she plans on staying in remote areas and spelunking in jungle caves.
  • She asks you whether rabies vaccination is warranted…

Case Conclusion

You informed the patient that her planned travel to Southeast Asia with plans to visit remote areas and explore caves would be risky activities for exposure to rabies. You initiated PrEP by administering 1-mL rabies vaccine, IM in the deltoid, and informed her that she will need a second dose in 3 days and third dose in 21 or 28 days. You explained that PrEP simplifies the PEP regimen in the case of a potential exposure, but does not eliminate the need for a second vaccine course. You also explained that, in case of an exposure, rabies biologics offered in resource-limited countries may be less potent and with more adverse effects than FDA-approved biologics, and she should present for follow-up evaluation and possible additional vaccines upon her return.

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Last Updated on January 26, 2023

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