Table 1.

Samples and methods recommended for rabies diagnosis in patients

Sample	Purpose	Method
Full thickness skin punch biopsy, including hair follicles‡	Antigen detection	IFA test on frozen vertical section † RT- PCR
Saliva★ or throat swab Tears CSF	Virus isolation   and Antigen detection	Tissue culture Mouse inoculation test   RT- PCR
Serum	Neutralising antibody test	Presence of antibody is diagnostic in unvaccinated patients Take sample on admission to save for comparison 7 days later
CSF	Neutralising antibody test	Test in parallel with serum
Brain post-mortem: Needle necropsy ¶ or Autopsy sample brain stem & cerebellum	Virus isolation   and Antigen detection	Tissue culture Mouse inoculation test   IFA test on impression smear ° RT- PCR

‡ Highest positivity rate; ^† rabies antigen seen in nerve twiglets around the base of hair follicles by immunofluorescence (IFA) test; ^★ easiest sample for antigen detection, repeat daily at least x 3, until a diagnosis is confirmed; ^¶ necropsies are taken with a long biopsy needle via the medial canthus of the eye through the superior orbital fissure; via the nose through the ethmoid bone; through the foramen magnum or open fontanelles in children; ° alternative: a direct rapid immunohistochemical test with biotinylated monoclonal antibodies and light microscopy.