Human rabies - Indiana and California, 2006
Morbidity and Mortality Weekly Report 04/2007; 56(15):361-365.
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ABSTRACT: Rabies is a preventable, fatal infectious disease. Successful vaccination programs for domestic animals in developed countries have drastically decreased the risk of exposure to rabies. Yet awareness of rabies needs to remain high as important reservoirs still exist in our backyards, the wilderness, and abroad. Recognizing the risk before and after a potential exposure, so that appropriate medical care can be sought, is critical to preventing a fatal complication. This case report involves an exposure of a medical student to an ill-appearing and likely rabid gray fox in the Gila Wilderness Area of New Mexico. The student was a member of a 28-day wilderness medicine course taught by the National Outdoor Leadership School/Wilderness Medicine Institute in collaboration with the Harvard Affiliated Emergency Medicine Residency. On the first night in the field, the student awoke to a gray fox biting his foot through his sleeping bag in the early morning hours. Subsequently the student was evacuated for medical evaluation. Further care consisted of rabies postexposure prophylaxis, including thorough wound cleansing, injection of human rabies immunoglobulin, and initiation of a rabies vaccination schedule. Immediate wound care with soap and water and a viricidal agent is of utmost importance for any animal bite, but especially so in the prevention of rabies. Indications for rabies prophylaxis are complex and require prompt evaluation by a medical professional and consultation with local epidemiology to guide treatment.Wilderness and Environmental Medicine 02/2009; 20(3):290-6. DOI:10.1580/08-WEME-CR-258R1.1 · 1.20 Impact Factor
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ABSTRACT: A 37-year-old woman was admitted to hospital and over the next 5 days developed a progressive encephalitis. Nuchal skin biopsy, analyzed using a Rabies TaqMan(c) PCR, demonstrated rabies virus RNA. She had a history in keeping with exposure to rabies whilst in South Africa, but had not received pre- or post-exposure prophylaxis. She was treated with a therapeutic coma according to the "Milwaukee protocol," which failed to prevent the death of the patient. Rabies virus was isolated from CSF and saliva, and rabies antibody was demonstrated in serum (from day 11 onwards) and cerebrospinal fluid (day 13 onwards). She died on day-35 of hospitalization. Autopsy specimens demonstrated the presence of rabies antigen, viral RNA, and viable rabies virus in the central nervous system.Journal of Medical Virology 07/2010; 82(7):1255-65. DOI:10.1002/jmv.21785 · 2.35 Impact Factor
Article: Therapy of Human Rabies[Show abstract] [Hide abstract]
ABSTRACT: Preventive therapy for rabies, including wound cleansing and active and passive immunization after a recognized exposure, is highly efficacious. Unfortunately, there is no established therapy that is effective for patients who develop rabies encephalomyelitis. There have been several survivors from rabies and all but one received rabies vaccine prior to the onset of clinical illness. Aggressive approaches to therapy of human rabies may be appropriate in certain situations. There is no scientific rationale for the use of therapeutic coma, and there are many reports of failures using this approach. Therapeutic coma should be abandoned for the therapy of rabies. New approaches such as therapeutic hypothermia should be evaluated, in combination with other therapeutic agents. More basic research is needed on the mechanisms involved in rabies pathogenesis, which will hopefully facilitate the development of new therapeutic approaches in the future for this ancient disease.Advances in Virus Research 01/2011; 79:365-75. DOI:10.1016/B978-0-12-387040-7.00017-2 · 4.57 Impact Factor
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