1/3. survival after treatment of rabies with induction of coma.We report the survival of a 15-year-old girl in whom clinical rabies developed one month after she was bitten by a bat. Treatment included induction of coma while a native immune response matured; rabies vaccine was not administered. The patient was treated with ketamine, midazolam, ribavirin, and amantadine. Probable drug-related toxic effects included hemolysis, pancreatitis, acidosis, and hepatotoxicity. Lumbar puncture after eight days showed an increased level of rabies antibody, and sedation was tapered. paresis and sensory denervation then resolved. The patient was removed from isolation after 31 days and discharged to her home after 76 days. At nearly five months after her initial hospitalization, she was alert and communicative, but with choreoathetosis, dysarthria, and an unsteady gait.- - - - - - - - - - ranking = 1keywords = rabies (Clic here for more details about this article) |
2/3. Failure of therapeutic coma and ketamine for therapy of human rabies.The recent success in treating a human rabies patient in Milwaukee prompted the use of a similar therapeutic approach in a 33-year-old male Thai patient who was admitted in the early stages of furious rabies. He received therapeutic coma with intravenous diazepam and sodium thiopental to maintain an electroencephalographic burst suppression pattern, which was maintained for a period of 46 h, as well as intravenous ketamine (48 mg/kg/day) as a continuous infusion and ribavirin (48 to 128 mg/kg/day) via a nasogastric tube. He never developed rabies virus antibodies and he died on his 8th hospital day. At least three other patients have been treated unsuccessfully with a similar therapeutic approach. Because of the lack of a clear scientific rationale, high associated costs, and potential complications of therapeutic coma, the authors recommend caution in taking this approach for the therapy of rabies outside the setting of a clinical trial. More experimental work is also needed in cell culture systems and in animal models of rabies in order to develop effective therapy for human rabies.- - - - - - - - - - ranking = 1.4285714285714keywords = rabies (Clic here for more details about this article) |
3/3. Human rabies: clinical features, diagnosis, complications, and management.A case of rabies was treated with intensive medical support. This led to a prolongation of life to 25 days. The neurologic progression of the disease was monitored clinically and with serial EEG. This prolonged course enabled us to witness and manage a wide variety of unusual complications including the adult respiratory distress syndrome, hypothermia, myocarditis, and diabetes insipidus. This report documents the clinical features, diagnostic problems, complications, and management.- - - - - - - - - - ranking = 0.71428571428571keywords = rabies (Clic here for more details about this article) |