A case report of a 52-year-old Missouri man who was diagnosed with rabies several days after first presenting to the hospital with symptoms underscores the importance of educating the public about potential rabies reservoirs, according to a paper from the Centers for Disease Control and Prevention.
A research team writing in the Morbidity and Mortality Weekly Report this week noted that “rabies is preventable after an exposure through timely postexposure prophylaxis, which includes wound washing and administration of rabies immune globulin and rabies vaccine.”
The man was evaluated several times after his initial presentation to an emergency room on Sept. 12, 2015. He reported having seen a bat in his home a year before his presentation to the hospital, and worked in an area where bats are seen, according to the report.
The man was initially diagnosed with muscle strain, and sent home with pain medications. The next day the man returned to the hospital with numbness in his arms, and worsening symptoms, according to the report. Over the next several days, he underwent a series of tests before rabies was confirmed on Sept. 24. During this time, his conditioned worsened, and he “required dopamine and norepinephrine for cardiovascular support, continuous mechanical ventilation for acute hypoxemic respiratory failure, and hemodialysis for acute kidney injury.” The family withdrew life support on Sept. 26.
The researchers noted that although “no evidence-based treatment approach for clinical rabies exists,the Milwaukee protocol, which was first used in 2004 in a Wisconsin patient who survived rabies infection, has been implemented with varying outcomes.”
Arming the public with knowledge about rabies is key, the researchers explained.
“Public education campaigns aimed at raising rabies awareness should address misconceptions about risk associated with bat encounters (eg, lack of knowledge that bats can transmit rabies through small, undetected bites) that can lead to a delay in the timely response to potential rabies virus exposures,” the researchers noted. “These campaigns should also emphasize the importance of completing the full rabies PEP series once initiated, unless the exposure source is determined not to be rabid through laboratory testing or successful (i.e., remains healthy) completion of a 10-day observation period for a dog, cat, or ferret. In addition to the importance of public education, health care workers should consider rabies in the differential diagnosis of any patient with acute, unexplained encephalitis, and use appropriate infection control practices when examining and treating patients with a suspected infectious disease.” Nine of the man’s family members and seven health care workers received PEP.
CDC. Human Rabies — Missouri, 2014. MMWR; 2016 / 65(10);253–256