1/153. Human rabies--virginia, 1998. On December 31, 1998, a 29-year-old man in Richmond, virginia, died from rabies encephalitis caused by a rabies virus variant associated with insectivorous bats. This report summarizes the clinical and epidemiologic investigations by the virginia Department of Health and CDC. ( info) |
2/153. Mokola virus infection: description of recent South African cases and a review of the virus epidemiology. Five cases of Mokola virus, a lyssavirus related to rabies, are described. The cases occurred in cats from the East london, Pinetown and Pietermaritzburg areas of south africa from February 1996 to February 1998. Each of the cats was suspected of being rabid and their brains were submitted for laboratory confirmation. Four of the cases were positive, but with atypical fluorescence, and 1 was negative. Mokola virus infection was identified by anti-lyssavirus nucleocapsid monoclonal antibody typing. As in rabies cases, the predominant clinical signs were of unusual behaviour. aggression was present, but only during handling. Four of the 5 cats had been vaccinated for rabies, which is consistent with other studies that show that rabies vaccination does not appear to protect against Mokola virus. Since Mokola may be confused with rabies, the incidence of Mokola virus may be more common in Africa than is currently reported. As human infections may be fatal, the emergence of this virus is a potential threat to public health. ( info) |
3/153. An arctic fox rabies virus strain as the cause of human rabies in Russian siberia. A case of human rabies in the arctic zone of siberia is described. The victim was bitten by a wolf, but characterization of the isolate by monoclonal antibodies showed that it was an arctic fox virus strain. This discovery reaffirmed the value of strain typing rabies virus isolates in regions where this has not been done already: such characterization pertains to the identification of the reservoir host, to the natural history of the virus in the reservoir, and to future surveillance, post-exposure treatment, and public education in the region. ( info) |
4/153. Preventing human rabies before and after exposure. Rabies is a viral disease that can be transmitted from animals to humans. Recently, most human deaths from rabies have been caused by transmission from bats, in many cases without a documented bite or exposure. Rabies is fatal if untreated prior to onset of symptoms. Deaths from human rabies in the united states are rare, largely because of animal control measures and postexposure prophylaxis of people who have been bitten or exposed to the virus. Primary care providers play a pivotal role in the prevention of rabies. Preexposure prevention involves education and immunization of persons at high risk for rabies exposure. Rabies is difficult to diagnose antemortem because of the nonspecific presentation of signs and symptoms that may mimic those of respiratory or abdominal infections. Diagnosing rabies once symptoms begin will not save the victim's life but will help to minimize exposure to others, allow for identification and prophylaxis of those who may have been exposed, and identify the animal vector. ( info) |
5/153. Trucut needle biopsy through superior orbital fissure for the diagnosis of rabies. Necropsy diagnosis of rabies can be done by taking a brain biopsy specimen with a trucut needle inserted through the superior orbital fissure into the cranial cavity. This technique reduces the number of personnel who require post-exposure prophylaxis and avoids full necropsy if the deceased's relatives are opposed. ( info) |
6/153. Survey of rabies preexposure and postexposure prophylaxis among missionary personnel stationed outside the united states. BACKGROUND: Of the 36 cases of human rabies that have occurred in the united states since 1980, 12 (33%) were presumed to have been acquired abroad. In the united states, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack immediate access to appropriate medical care, including vaccine and rabies immune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while stationed in bangladesh highlighted this high-risk group. methods: To assess their knowledge of rabies risk, rabies exposures, and compliance with preventive recommendations, we asked 695 missionaries and their family members to complete questionnaires about their time stationed abroad. RESULTS: Of the 293 respondents stationed in countries where rabies is endemic, 37% reported prior knowledge of the presence of rabies in their country of service. Only 28% of the personnel stationed in rabies-endemic countries received preexposure prophylaxis. Having preexposure prophylaxis specifically recommended increased the likelihood of actually receiving it (O.R. 15.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, another human = 20%), proven or presumed to be rabid. Three of the people exposed received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment. CONCLUSIONS: Although American missionaries stationed abroad are at an increased risk for exposure to rabies, compliance with established preventive measures was low. Prior to being stationed abroad, an educational rabies-prevention briefing, including encouragement to receive preexposure prophylaxis, could be an effective intervention for missionaries to decrease their risk of rabies. ( info) |
7/153. Rabies control in japan. In 1957 japan succeeded in eradicating rabies, which had been endemic since the 18th century, due to the registration and confinement of family dogs, the elimination of stray dogs, and the compulsory vaccination of dogs. At present, however, vaccination coverage of family dogs is far lower than the required level of 70%. The facilities that are presently able to investigate rabies are limited in number. In addition, few medical institutions keep rabies vaccine in stock or offer postexposure vaccination to travelers bitten by animals in rabies endemic areas. Moreover, rabies immunoglobulin (RIG) cannot be given to such individuals because RIG is not produced at present in japan, nor is it authorized to be imported. To keep japan free from any rabies deaths, an improvement in vaccination coverage among dogs and in the supply of postexposure prophylaxis is required, and the establishment of a rabies surveillance system is also considered to be essential. ( info) |
8/153. Boerhaave's syndrome (ruptured oesophagus) in a case of rabies. A 46-year-old Caucasian man was admitted with a history of dog-bite in a foreign country six months previously. He presented with multisystem complaints, died suddenly soon after admission and the only significant finding at post-mortem was a ruptured oesophagus. Immunological tests confirmed rabies. ( info) |
9/153. Rabies in israel: decades of prevention and a human case. Animal rabies is endemic in israel, with 50-80 laboratory-confirmed cases being diagnosed annually. Despite the high incidence among animals, human rabies has not occurred in israel for almost four decades. This is likely due to the highly effective prevention policy implemented by the Ministry of Health, based on pre-exposure vaccination of populations at risk, post-exposure treatment, and updated rules. Notwithstanding the previous success, a human case occurred in 1996 when a soldier was bitten, while asleep, by an unidentified small animal, which according to his description was a rat or a mouse. Since injuries by these rodents do not require antirabies treatment, no antirabies post-exposure prophylaxis was administered. Five weeks later the soldier complained of fever and nausea with interchanging periods of rage and calm, confusion, and water aversion. His condition deteriorated gradually, leading to deep coma and death. Immunofluorescence examination of a skin biopsy was positive for rabies, and PCR of saliva revealed lyssavirus genotype 1. We review the changes in the epizootiology of rabies in israel, the trends of human exposure to animals, and the pre- and post-exposure prophylaxis guidelines, and discuss possible measures that could have been undertaken to prevent the eventuality of this case. This case of rabies, the first after a long period without human disease, accentuates the importance of strict adherence to prevention guidelines. Considerations of geography, epidemiology, and the circumstances of exposure are crucial in the treatment decision-making process. ( info) |
10/153. Correlation of clinical and neuroimaging findings in a case of rabies encephalitis. BACKGROUND: Rabies encephalitis is a feared, virtually uniformly fatal form of central nervous system infection. The incidence of rabies encephalitis in the united states is almost certainly underestimated because of the predominance of bat-borne rabies, which can be spread without traumatic exposure. Because of its rarity in developed countries, rabies encephalitis has been seldom studied with modern imaging techniques. SETTING: University-based teaching hospital. PATIENT: A case of pathologically confirmed rabies encephalitis is presented. diagnosis of rabies was made by seroconversion testing while the patient was alive and was confirmed postmortem by the presence of rabies antigens and Negri bodies in the brain. The patient had 2 magnetic resonance studies done that showed dramatic abnormalities in the medulla and pons that correlated with features of the neurologic examination and hypothalamic-pituitary abnormalities. RESULT: The patient had a fulminant encephalitic course that ended in death. CONCLUSION: Rabies is an uncommon cause of fatal encephalitis. Anatomic imaging studies such as computed tomographic and magnetic resonance scans have generally been negative in confirmed cases of rabies. We report a case of confirmed rabies with extensive brainstem and hypothalamic-pituitary abnormalities on magnetic resonance imaging. Although these findings are nonspecific, they should raise the clinical suspicion of rabies in the setting of aggressive encephalitis of unclear cause, and appropriate diagnostic tests should be performed. ( info) |