Antemortem diagnosis of rabies — Which clinical specimens are suitable for demonstrating rabies antigen by direct immunofluorescence in living patients?

Introduction / Context:
Early diagnosis of rabies is critical because the disease is almost uniformly fatal once symptomatic. Antemortem testing leverages direct immunofluorescence (DFA/IF) on accessible tissues to detect viral antigen.

Given Data / Assumptions:

• Direct immunofluorescence targets rabies nucleocapsid antigens in exfoliated epithelial cells or tissue imprints.
• Sampling must be minimally invasive and repeatable.
• Multiple sites increase diagnostic yield when combined with RT-PCR on saliva/CSF and skin biopsies.

Concept / Approach:
Saliva contains infected epithelial cells and virions; corneal and conjunctival impression smears capture infected epithelial cells. These are recognized clinical specimens for antemortem antigen detection by direct IF in appropriate laboratory settings.

Step-by-Step Solution:

Verification / Alternative check:
Diagnostic algorithms also include nuchal skin biopsy (hair follicles) for DFA and RT-PCR, but this does not invalidate the listed smear specimens for antigen detection.

Why Other Options Are Wrong:

• Selecting only one smear type lowers sensitivity; standard protocols may use multiple specimen types.

Common Pitfalls:
Assuming brain biopsy is required antemortem; less invasive smears and biopsies are preferred initially.

Final Answer:
All of these