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RABIES IS ALMOST ALWAYS FATAL ONCE SYMPTOMS START
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OKAY BACK FROM THE ISOLATION ROOM 🧫
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A DOG BITE ABROAD AND A DEATH IN THE UK ✈️
A Paper Reports A Rabies Case Imported Into The United Kingdom
The Authors Call It The Fifth Rabies Case In The UK Since 2000
A 58 Year Old British Asian Woman Was The Patient
She Was Referred To A Regional General Hospital In The UK
That Was Nine Weeks After A Dog Bite In North West India
The Bite Was On Her Right Forearm From An Ownerless Puppy
Her Symptoms Included Hydrophobia Anxiety And Confusion
A Blood Sample Was Taken First
She Then Received Vaccine And Human Rabies Immunoglobulin
Her Hydrophobia Had Already Begun By Then
Serum Taken Before The Vaccine Was Negative For Rabies Antibodies
She Was Later Moved To An Isolation Room In An Intensive Care Unit
On Arrival There She Showed Pronounced Hydrophobia
Saliva And Skin Biopsies Tested Positive For Lyssavirus RNA
The Virus Was Closely Related To Canine Rabies Viruses In South Asia
She Was Treated According To A Modified Milwaukee Protocol
Heart Block And Profound Acidosis Developed And She Died
The Authors Say Vaccine And Immune Globulin Came Before The Protocol
They Say That May Have Delayed Her Immune Response
At Autopsy Her Spinal Fluid And Serum Had No Neutralizing Antibody
The Authors Say Her Case Supports Earlier Evidence
That Evidence Calls Absent Spinal Fluid Antibody A Bad Prognostic Sign
The Paper Calls Management Guided By The Protocol Feasible
That Applies Within Well Resourced Intensive Care Units
The Protocol's Benefit For Rabies From Dogs Remains Theoretical
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THE MILWAUKEE PROTOCOL 💊
The Protocol Began With The Treatment Of A 15 Year Old Girl
That Girl Had A Bat Bite On Her Right Hand
She Was Kept In An Induced Coma With Deep Sedation
The Antivirals Amantadine And Ribavirin Were Part Of Her Treatment
She Survived With A Few Sequelae
That Treatment Became Known As The Milwaukee Protocol
A Review Compared It With Brazil's Recife Protocol
The Review Says Its Effectiveness Cannot Be Estimated Quantitatively
Adoption Remains Contentious According To The Paper On The Woman
That Paper Also Calls The Logistical Complexities Substantial
A Report On A Bat Exposure Case Tried It On Its Patient
The Authors Started The Protocol 15 Days After Symptom Onset
There Was No Evidence Of Recovery Despite The Protocol
That Report Also Cites Five Other Recently Described Cases
Those Patients Were Treated With The Milwaukee Protocol
No Patient Among Them Had Received Postexposure Prophylaxis
All Of Them Presented With Clinical Disease
None Of Them Survived
A Study Of Spinal Fluid Compared Rabies Survivors And Nonsurvivors
It Says A Teenager Survived In 2004 Through Improvised Supportive Care
Since Then Five Additional Survivors Were Associated With The Protocol
A Case Report On A Surviving Boy Discusses The Protocol
The Report Says Subsequent Users Found No Reduction In Mortality Rates
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SURVIVING RABIES WITH DISABILITIES 🩼
The Boy In That Report Was 13 Years Old And From India
A Street Dog Had Bitten His Right Hand
He Received Aggressive Supportive Care
The Authors Managed Him Without The Milwaukee Protocol Or Steroids
He Was Weaned Off The Ventilator After Eight Weeks Of Illness
His MRI Scans Showed Reduced Hyperintensities
They Also Showed Marked Cortical Atrophy
His Discharge Came In Stable Condition
Severe Neurological Sequelae Were Present At Discharge
Two Months After Discharge He Could Make Meaningful Eye Contact
He Could Also Follow Single Step Commands
The Report Calls Reasons For Survival Always Conjectural
Its Discussion Calls Rabies Encephalitis Almost Always Fatal
It Adds That Therapy Has Mostly Been Palliative
A CDC Report Says There Is No Treatment Once Signs Or Symptoms Begin
The Bat Exposure Report Notes Survival In Isolated Cases
Those Isolated Cases Involved Patients Who Were Symptomatic
Every Survivor It Cites Had Received Pre Or Postexposure Prophylaxis
None Of Them Had Positive Test Results For Rabies Virus
Nearly All Of These Survivors Had Disabling Neurologic Sequelae
