Bacterial and viral cultures and test results for Lyme disease and tuberculosis were negative. Initial cerebrospinal fluid, serum, skin, and saliva specimens were negative for rabies. A corneal impression test was performed. Immunofluorescent antibody staining of the epithelial cells on the corneal impression test was positive for rabies. Subsequently, the diagnosis was confirmed by serum serologic analysis and saliva testing.
Ophthalmologists can assist in the diagnosis of rabies by using the corneal impression test.
Corneal smears should be part of the routine antemortem work-up for presumptive rabies.