# Diagnosis of Paralytic Rabies by Metagenomics Next‐Generation Sequencing: A Case Report and Review of the Literature

## TL;DR

A rare case of paralytic rabies was diagnosed using metagenomic sequencing, showing its value in identifying hard-to-detect brain infections.

## Contribution

Demonstrates the novel use of metagenomic next-generation sequencing for diagnosing atypical rabies cases.

## Key findings

- Metagenomic next-generation sequencing detected rabies virus in cerebrospinal fluid when traditional methods failed.
- The case highlights mNGS as a rapid and precise diagnostic tool for elusive neurotropic infections.
- mNGS can guide clinical management in unexplained encephalitis cases.

## Abstract

Paralytic rabies is an atypical form of the disease that is notoriously difficult to diagnose early due to the absence of classic features like hydrophobia. The case being discussed presents a patient who has altered mental status, for whom the initial diagnosis was difficult due to an absent clear bite history and typical symptoms. The final diagnosis of the case was confirmed by metagenomic next‐generation sequencing (mNGS) of directly from cerebrospinal fluid, which led to the detection of the rabies virus. This case underscores the critical diagnostic value of mNGS in identifying elusive neurotropic infections.

This case report demonstrates the successful diagnosis of a challenging paralytic rabies case using metagenomic next‐generation sequencing (mNGS). mNGS provided a rapid and precise pathogen identification directly from cerebrospinal fluid where traditional methods failed. This highlights the critical role of mNGS as a powerful diagnostic tool for uncovering elusive neurotropic viruses and guiding clinical management in unexplained encephalitis cases.