Antemortem Diagnosis of Human Rabies

NOTE: Prospective submitters should make prior arrangements for testing with the rabies laboratory Director by telephone.

1. The diagnosis of rabies for human patients with symptoms indicative of rabies infection can be achieved with the following tests:

a. fluorescent antibody test on punch biopsy of skin from the nuchal region
b. fluorescent antibody test on corneal impressions
c. in vitro virus isolation from saliva
d. virus neutralization assay on serum, for evidence of rabies antibody
e. virus neutralization assay on cerebrospinal fluid, for evidence of rabies antibody
f. rt-pcr for viral RNA and genomic nucleotide sequence analysis on saliva

2. Rabies infection is confirmed by: demonstration of rabies antigen in skin biopsy or corneal impressions; positive results with virus isolation; evidence of rabies antibody in serum and CSF; or a pcr product with nucleotide sequence homologous with rabies virus. Negative results with these procedures do not rule-out rabies infection, as antemortem tests may remain negative well into the clinical period of rabies infection.

3. Submit at least 1.0 ml each of serum and CSF. Corneal impressions should be taken by an opthalmologist, by firmly rubbing a flat surface of a clean microscope slide on each cornea (the slide should be labeled to identify the surface with the impression). The saliva sample (one ml) can be aspirated into a plastic sputum jar or tube. The punch biopsy should be from the back of the neck, full thickness, 0.3 - 0.5 centimeter in diameter and include a few hair follicles. All ante-mortem samples should be quickly frozen and stored at -70 degrees Celcius until submission.

4. All samples should be collected, packaged and transported under strict isolation and biocontainment practices.

5. Physicians and pathologists must be reminded that should the patient die, fresh (not fixed) brain tissue (refrigerated or frozen), including one cubic-centimeter piece each of cerebellum and brainstem, should be submitted for immunofluorescence examination and virus isolation.

6. Communications:

Workdays: 518-869-4527
After-hours, weekends, Holidays: 518-527-7369 or 527-7370
e-mail: rjr06@health.state.ny.us

Ship to:
Robert Rudd, Director, Rabies Laboratory
Griffin Laboratory
5668 State Farm Rd.
Slingerlands, NY 12159