Background In the Amazonian region, vampire bats are the primary reservoir of rabies virus, causing sporadic and lethal human rabies cases that often remain unnoticed. Managing human cases in this region is challenging and further complicated by atypical clinical forms and the potential exposure to various toxic compounds, particularly among gold miners. Methods We carried out clinical, electrical, biological and histological analysis of concurrent cases of progressive motor neuronopathy and fatal encephalitis in a context of regular exposure to bat bites of gold miners living in a small and remote gold mine camp in Amazonia, in French Guiana, South America. Findings We analyzed a spatio-temporal cluster of three suspected rabies cases in 2024 with a fatal outcome, with concomitant onset of acute bilateral lower-limb paralysis without demyelination, two of which occurred presumably two weeks after a bat-bite. Electroneuromyography suggested the involvement of the anterior horn of the spinal cord, as described in furious forms of rabies. None of the cases exhibited other cardinal signs of the furious form. Confirmation of rabies was obtained for them on sera and brain biopsies collected ante- and post-mortem respectively. Interpretation The concurrent occurrence of disease, the axonal motor neuropathy mimicking the motor form of Guillain Barré syndrome in the context of paralytic rabies, lead to diagnostic-wandering. This underscores the importance of thinking about vampire bat rabies virus in the presence of any atypical neurological picture in patients living in exposed areas in Latin America.
Deschamps et al. (Mon,) studied this question.