Human Case ofBartonella alsaticaLymphadenitis

6).The sequence is distinct from a small number of sequences derived from rabies viruses in Vietnam, which suggests that China is a stronger candidate for the source of the virus than her native country.Although the case history could not provide evidence for interaction with a dog while her family was in Hong Kong Special Administrative Region, rabies was endemic within the colony at the time that the patient's family was resident.From 1980 through 1984, 5 human cases were recorded (9).Only 2 case-patients had clear evidence of a dog bite; histories for the remaining 3 cases provided no evidence for an animal bite.From 1956 to 1979, Hong Kong had been free of rabies, but the disease had reentered the colony shortly after its incidence had increased in the neighboring Chinese province of Guangdong.If Hong Kong was where the young girl was infected, it would indicate an incubation period of 4.5-6 years.Such long incubation periods are rare for rabies virus infections.An earlier epidemiologic study of 177 cases in Amritsar, India, demonstrated that rabies developed within 6 months of exposure in 90% of human cases (10).However, the thorough documentation of a small number of cases (1,2) suggests that clinicians need to be aware of the importance of including travel history over several years in cases of unexplained encephalitis.