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11/34. Fatal human rabies caused by European bat lyssavirus type 2a infection in scotland.

    We wish to report the first recorded case of indigenous human rabies caused by a bat bite in the United Kingdom in 100 years. This instructive case report highlights a number of key lessons: first, bites from insectivorous bats indiginous to the United Kingdom can cause rabies in humans; second, rabies immunization is essential for bat-handlers, and postexposure treatment for rabies is essential for patients bitten by bats; third, patients able to give a history who present with acute flaccid paralysis and/or presumptive viral encephalitis should be asked if they have been bitten by bats, irrespective of travel history, or this history should be obtained from family or friends; fourth, antemortem diagnosis of bat rabies (EBLV type 2a infection) in humans is possible using RT-PCR.
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12/34. Case report: isolation of a European bat lyssavirus type 2a from a fatal human case of rabies encephalitis.

    A 55-year-old bat conservationist was admitted to Ninewells Hospital, Dundee, scotland, on November 11, 2002, with an acute haematemesis. He gave a 5-day history of pain and paraesthesia in the left arm, followed by increasing weakness of his limbs with evidence of an evolving encephalitis with cerebellar involvement. The patient had never been vaccinated against rabies and did not receive postexposure treatment. Using a hemi-nested reverse transcriptase-polymerase chain reaction (RT-PCR), saliva samples taken intravitam from different dates proved positive for rabies. A 400-bp region of the nucleoprotein gene was sequenced for confirmation and identified a strain of European bat lyssavirus (EBLV) type 2a. The diagnosis was confirmed using the fluorescent antibody test (FAT) and by RT-PCR on three brain samples (cerebellum, medulla, and hippocampus) taken at autopsy. In addition, a mouse inoculation test (MIT) was performed. Between 13 and 17 days postinfection, clinical signs of a rabies-like illness had developed in all five inoculated mice. brain smears from each infected animal were positive by the FAT and viable virus was isolated. This fatal incident is only the second confirmed case of an EBLV type-2 infection in a human after exposure to bats.
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keywords = rabies
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13/34. Cougar attacks on humans: a case report.

    Cougar attacks on humans are increasing. Presented is a case report of a nonfatal 2-year-old male cougar attack on an 8-year-old girl in british columbia. Discussions of wound management, rabies postexposure prophylaxis (RPEP), and the possible psychologic ramifications of such an attack are presented. Also reviewed are recommendations on actions that may be helpful in preventing an attack following a sudden encounter with a cougar. humans must learn to coexist with cougars, which present a small but real threat to people.
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keywords = rabies
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14/34. Rabies encephalitis following fox bite--histological and immunohistochemical evaluation of lesions caused by virus.

    Rabies caused by fox bite is uncommon, most cases being caused by bite of rabid dogs (95%). We report a 45-year-old lady with rabies encephalomyelitis caused by bite of a rabid wild fox (Vulpes vulpes), a species prevalent in the Deccan plateaus of Central india. Though foxes are known to be susceptible to rabies, literature on the pathological changes caused by fox bite rabies in humans is scarce. Unlike the mild histological alterations described in canine rabies, a florid encephalitic process evolved in fox bite rabies, in our case, with intense microglial reaction, neuronophagia and perivascular inflammatory infiltrates despite clinical manifestation as a paralytic rabies. Immunostaining using polyclonal antibodies to the rabies viral nucleocapsid antigen and to the whole virion demonstrated high viral load within neurons with extensive spread along dendritic arborization and axonal tracts. Genomic sequence analysis demonstrated close homology with canine virus strain with only minor variations.
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keywords = rabies
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15/34. Recovery of a patient from clinical rabies--wisconsin, 2004.

    Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and is nearly always fatal without proper postexposure prophylaxis (PEP). In October 2004, a previously healthy female aged 15 years in Fond du Lac County, wisconsin, received a diagnosis of rabies after being bitten by a bat approximately 1 month before symptom onset. This report summarizes the investigation conducted by the wisconsin Division of public health (WDPH), the public health response in Fond du Lac County, and the patient's clinical course through December 17. This is the first documented recovery from clinical rabies by a patient who had not received either pre- or postexposure prophylaxis for rabies.
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keywords = rabies
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16/34. travel-associated rabies in Austrian man.

    Rabies developed in an Austrian man after he was bitten by a dog in Agadir, morocco. diagnosis was confirmed by reverse transcription-polymerase chain reaction and immunohistochemistry. The patient's girlfriend was bitten by the same dog, but she did not become ill.
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ranking = 0.44444444444444
keywords = rabies
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17/34. 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.
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keywords = rabies
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18/34. Human rabies--florida, 2004.

    Rabies is a viral infection of the central nervous system, usually contracted from the bite of an infected animal, and nearly always fatal without postexposure prophylaxis. In February 2004, a man aged 41 years died after a 4-day hospitalization in Broward County, florida. A diagnosis of rabies was considered on the day before the patient's death; however, no antemortem samples were obtained for testing. In March 2004, postmortem samples of fixed brain material were sent to CDC, where laboratory testing confirmed a diagnosis of rabies, the 47th case of human rabies reported in the united states since 1990 (CDC, unpublished data, 2005). This report summarizes results of the subsequent investigation led by the Broward County Health Department and laboratory testing at CDC, which determined that the rabies virus was a canine variant present in haiti, where the man had traveled and reportedly been bitten by a dog. Rabies should be considered in persons after a dog bite, especially if the bite occurs in a country where canine rabies is enzootic.
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19/34. rabies virus infection in a pet guinea pig and seven pet rabbits.

    Raccoon-variant rabies was confirmed in 7 pet rabbits and 1 pet guinea pig in new york State, and postexposure treatment was required in several adults and children. To prevent rabies virus infection, domestic rabbits and pet rodents should be protected from contact with wild animals, including double-cage housing when housed outside. Pet rabbits or rodents with any possible contact with a wild animal, particularly if the rabbit or rodent had wounds of unknown origin, should be quarantined for 6 months for observation, to prevent escape, and to avoid contact with humans, who will require treatment if the rabbit or rodent develops rabies. Bites and scratches to humans from rodents and lagomorphs should be evaluated for potential rabies exposure on an individual basis, with consideration of whether the animal was caged outside or permitted outdoors unsupervised.
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keywords = rabies
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20/34. Rabies case in new south wales, 1990: public health aspects.

    OBJECTIVES: To identify the source of rabies in the recent case in new south wales, and to determine the need for post-exposure rabies prophylaxis among contacts of the patient. DESIGN: Information was obtained by face-to-face interview of the dead girl's family and face-to-face and telephone interviews using a questionnaire of health care workers. Other information was gathered from overseas and local sources through telephone and facsimile contact. RESULTS: The girl had migrated from vietnam in 1984 to hong kong, and from there in 1986 to australia. No evidence of contact with a rabid animal in australia or hong kong was found. There had also been no organ donations from the girl. Four health care workers were given post-exposure rabies prophylaxis. CONCLUSIONS: Because of the lack of evidence of animal contact in australia and the fact that extremely long incubation periods for rabies have been documented, it was considered that the most likely source of the rabies virus was North vietnam. Genetic studies of the virus also supported a South-East Asian source. Nevertheless the presumed incubation period--at least six years and four months--is one of the longest recorded.
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keywords = rabies
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