Cases reported "Encephalitis"

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1/11. Imported human rabies--france, 1992.

    Wildlife rabies has been enzootic in france since 1968; however, 13 of the 14 human cases in france were imported, and one was in a person infected through a corneal transplant (1). On May 9, 1992, a 3-year-old boy who resided in algeria died from rabies encephalitis in paris. This report summarizes the investigation of this case by the Pasteur Institute.
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2/11. Human rabies--california, 1992.

    On May 8, 1992, an 11-year-old boy died of rabies encephalitis in Fresno County, california. This was the 10th case of human rabies in the united states since 1980 known to be acquired outside the country and the first case reported in california since 1987. This report summarizes the investigation of the case.
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3/11. Human rabies--texas, 1990.

    On June 5, 1990, a 22-year-old man died of rabies encephalitis in Hidalgo County, texas, along the Mexican border. This was the fourth case of human rabies known to be acquired in the united states since 1980 and the first case in texas since 1985. This report summarizes the case investigation.
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4/11. Failure of interferon alfa and tribavirin in rabies encephalitis.

    OBJECTIVE--To test the effect of interferon alfa and tribavirin (ribavirin) in patients with rabies encephalitis. DESIGN--An open trial of chemotherapy and intensive care in patients with early rabies. SETTING--The intensive care unit of a Bangkok hospital. patients--Four conscious men with clinical rabies encephalitis. INTERVENTIONS--Rapid virological diagnosis of rabies. Treatment with intravenous and intraventricular injections of high doses of lymphoblastoid interferon alfa in three patients and tribavirin in one patient. intensive care was given throughout. MAIN OUTCOME MEASURES--Rabies infection confirmed by antigen detection and virus isolation. Rabies neutralising antibody and specific IgM sought in serum and cerebrospinal fluid. Interferon concentrations monitored before and during treatment in three patients. RESULTS--Interferon alfa treatment produced high concentrations in serum and cerebrospinal fluid. All four patients died after 5 1/2 to 12 1/2 days of treatment with no evidence of virostatic or clinically beneficial effects from either treatment. CONCLUSION--Interferon alfa treatment is not effective in rabies encephalitis. The use of tribavirin warrants further study, possibly combined with new therapeutic methods.
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5/11. Rabies presenting with myocarditis and encephalitis.

    We report a case of rabies acquired in zambia by a 45-year-old woman who presented with a history of an influenza-like illness, abnormal behaviour and signs of myocarditis. A provisional diagnosis of systemic viral infection was made. Within 12 h of admission the patient developed features of rabies that included hydrophobia. She was artificially paralysed and ventilated electively. Empirical antibiotic therapy was given also. Signs of myocarditis and fever disappeared within 48 h. Her clinical condition remained stable but she required heavy sedation. On the ninth day after admission the patient developed features of inappropriate secretion of antidiuretic hormone and gradually became water-logged. Intake of fluid was therefore restricted. Her level of consciousness deteriorated progressively to the point where sedation was no longer required. brain death was diagnosed 14 days after admission.
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keywords = rabies
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6/11. Fatal encephalitis caused by a bat-borne rabies-related virus. Clinical findings.

    The clinical findings are described in the first reported European case of fatal encephalitis of bat origin caused by a rabies-related virus. A bat zoologist developed the symptoms of rabies 51 days after his last exposure to a bat bite. The clinical disease of 23 days duration was a combination of the paralytic and 'furious' forms of rabies. Serial BAEP and EEG recordings, CT and MR scans of the brain, as well as CSF findings, demonstrated severe ascending destruction of the brain. An unusual progression from isolated brainstem death to cortical brain death occurred. Neuropathologically, the brain showed severe lytic changes. The presence of rabies-related virus antigens in brain smears was shown using a panel of fluorescent antibodies. The virus was inoculated into and isolated from suckling mice. The virus had a close resemblance to European bat rabies isolates, which belong to the group of rabies-related viruses. Of particular concern is whether the virus can spread from bats to terrestrial animals and whether the European type of bat rabies constitutes a danger to man.
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7/11. Airborne rabies encephalitis: demonstration of rabies virus in the human central nervous system.

    A veterinarian contracted rabies in the course of laboratory work with homogenates of rabid goat brain. Epidemiologic study determined a respiratory mode of transmission. After a fulminant encephalitic illness, formed rabies virions were identified in the synaptic zones of the olfactory glomeruli. Identification, isolation, experimental disease production, and tissue cytopathic effects of virus recovered from the brain fulfilled Koch's postulates in this unusual instance of virus disease of the nervous system.
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8/11. Rabies encephalitis: management in a district general hospital ICU.

    A brief description is given of the treatment of a case of rabies encephalitis. The problems of isolation and monitoring are described with a view to the provision of optimum care for future cases in the United Kingdom.
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9/11. Pathophysiologic studies in human rabies.

    Six patients with proved rabies were studied with a combination of clinical, physiologic and pathologic technics. Three were given a type of intensive care but died with evidence of respiratory failure. Although circulatory failure did not develop in any of the six patients, three had supraventricular arrhythmias: interstitial myocarditis was found in one of these and rabies virus was isolated from the myocardium of another. Inspiratory muscle spasm was the dominant clinical feature in all cases. This occurred as part of the hydrophobic response and followed stimulation of the upper respiratory tract and skin. Hydrophobia may represent an exaggerated respiratory tract irritant reflex with associated arousal. Later in the course of the disease, various patterns of periodic and ataxic breathing were observed. Widespread brain stem encephalitis was discovered at autopsy, with particular involvement of the neighborhood of the nucleus ambiguous in two of three patients examined. In one patient cerebral metabolism was grossly abnormal, with greatly reduced cerebral oxygen consumption suggesting irreversible brain damage. Respiratory and circulatory disturbances may well be immediate causes of death in patients with rabies, but the present studies reemphasize the severity of the encephalitis which remains the ultimate barrier to survival. In the developing countries in which rabies is still a major problem and in which the cost precludes intensive care, the clinical management of rabies can aim only to reduce suffering by heavy sedation.
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10/11. Rabies encephalitis in a patient with no history of exposure.

    A 29-year-old man died of a rapidly progressive encephalitis without a clinical diagnosis and without a history of exposure to the rabies virus. A diagnosis of rabies was established postmortem by histologic and ultrastructural demonstration of rabies virus inclusions, by fluorescent antibody reaction, and by viral culture. Viral inclusions were sparse, were generally irregular and poorly demarcated, and were confined almost exclusively to the cerebellar purkinje cells. A history of exposure was obtained only in retrospect on detailed questioning of friends and relatives. Rabies encephalitis is now seen most frequently in patients without a history of exposure and may be easily overlooked both clinically and pathologically.
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