Phylogenetic and epidemiologic evidence of multiyear incubation in human rabies

Ann Neurol. 2014 Jan;75(1):155-60. doi: 10.1002/ana.24016. Epub 2014 Jan 23.


Eight years after emigrating from Brazil, an otherwise healthy man developed rabies. An exposure prior to immigration was reported. Genetic analysis revealed a canine rabies virus variant found only in the patient's home country, and the patient had not traveled internationally since immigrating to the United States. We describe how epidemiological, phylogenetic, and viral sequencing data provided confirmation that rabies encephalomyelitis may present after a long, multiyear incubation period, a consideration that previously has been hypothesized without the ability to exclude a more recent exposure. Accordingly, rabies should be considered in the diagnosis of any acute encephalitis, myelitis, or encephalomyelitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Animals
  • Brazil
  • Dogs
  • Emigrants and Immigrants*
  • Humans
  • Infectious Disease Incubation Period*
  • Male
  • Phylogeny*
  • Rabies / cerebrospinal fluid*
  • Rabies / diagnosis*
  • Time Factors
  • United States