Cases reported "Rabies"

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21/43. 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.
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22/43. Confirmed rabies exposure during pregnancy: treatment with human rabies immune globulin and human diploid cell vaccine.

    A review of the literature shows 24 cases of pregnant human exposure to rabies virus through confirmed rabid animal bites. Historically, these patients received passive immunization with equine rabies immunoglobulin and/or purified vero cell vaccine or duck embryo vaccine. With the recent development of human-derived rabies vaccines, we report an additional case of human gestational rabies exposure, which was treated with human rabies immune globulin and human diploid cell vaccine.
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23/43. Unexplained rabies in three immigrants in the united states. A virologic investigation.

    BACKGROUND. Extensive investigation of three patients who died of rabies in the united states failed to reveal any source of exposure to the disease. The three patients had immigrated to the united states from areas in laos, the philippines, and mexico where rabies is endemic. methods. We studied rabies viruses isolated from the three patients, other patients with a known source of exposure, and animals in the united states, thailand (as a proxy for laos), the philippines, and mexico. The viruses were characterized by indirect immunofluorescence and neutralization tests according to their reactions to panels of monoclonal antibodies. Transcribed complementary dna from these isolates was amplified by the polymerase chain reaction; the dna product was then analyzed by differential digestion with restriction enzymes. RESULTS. The viral isolate from each of the three patients was a rabies variant with distinctive antigenic or genetic characteristics. For each of the three isolates, identical variants were found in specimens from rabid animals obtained from or near the country in which the patient lived before immigrating to the united states. None of these variants were found among the isolates collected from rabid animals in the united states. CONCLUSIONS. Rabies infection in these three patients did not originate in the united states but resulted from exposures in laos, the philippines, and mexico. Since the three patients had lived in the united states for 4 years, 6 years, and 11 months, our findings suggest that the onset of the clinical manifestations of rabies occurred after long incubation periods.
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24/43. 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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25/43. Emergence of antirabies vaccine of unknown origin for human treatment in nigeria.

    Rabies is endemic in nigeria. It is one of the most important and dreadful zoonotic diseases in the country and the dog is seen as the principal host and reservoir animal. Fatal human rabies resulting from dog bites has been reported. Dog bites in nigeria occur regularly throughout the year and the rate of bite could be considered very high. The treatment of the exposed has been a matter of concern.
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26/43. Pleomorphism of fine structure of rabies virus in human and experimental brain.

    Identification of the Negri bodies in the brain of an 8-year-old boy who died 8 days after a paralytic illness and 20 days after a dog bite, and who had received 9 injections of Semple's anti-rabies vaccine, provided evidence that he died of acute rabies encephalitis and not of post-vaccinal allergic encephalomyelitis. The Negri bodies in the human subject and those seen in the inoculated mouse differed in their morphological structure: the former consisted of a matrix of very fine granular material bearing larger granules or strands of higher electron-density resembling nucleic acids and representing products of host cell-virus interaction; and the latter showed better defined areas of granular matrix containing tubular, bullet-shaped and elongated forms of viral structures, and nucleocapsids or capsule-deficient cores, representing the virions, emerging from them. Fine structural examination of the patient's brain and of the inoculated mouse has provided evidence of the pleomorphism of the Negri bodies and the various stages of formation of viral material and virions in them, the animal alone showing the mature virions of rabies, and proving the infectivity of the Negri bodies of the human brain.
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27/43. On the replication and spread of rabies virus in the human central nervous system.

    Ultrastructural and immunohistochemical studies on the brains of two autopsy cases of human rabies revealed: By the peroxidase-antiperoxidase method, viral antigens were present in all eosinophilic inclusions detected in formalin fixed paraffin sections. Numerous antigenic masses, which apparently corresponded to the matrices and cylindrical particles in neurites revealed by electron microscopy, were present in the neuropil remote from neuronal perikarya. There were virions in the intercellular spaces and virus-budding from the plasma membrane into the extracellular space in the absence of a matrix, strongly indicating that rabies virus in the human central nervous system could spread through the intercellular spaces and that the replication of the virus was not necessarily accompanied by the formation of inclusion bodies. The synapse was involved in rabies as indicated by virions in the synaptic terminals. The implications of these observations are discussed in conjunction with the results of previous in vitro and animal experiments.
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28/43. Rabies in the united states and canada, 1983.

    Primarily as a result of organized canine rabies vaccination, leash laws, and other preventive procedures aimed at the canine population, the number of rabid dogs decreased markedly in the last thirty years (Figure 10). This decrease was accompanied by a similar marked reduction in human rabies (Table 2, Figure 11). As domestic animal rabies declined, rabies in wildlife increased. Since 1958 the number of cases of rabid wildlife surpassed domestic rabies cases, and today they account for over 85% of all reported rabies cases. In 1983, a total of 5,880 laboratory-confirmed cases of rabies in the united states and its territories were reported to CDC-a decline of 398 cases compared with 1982 (7) (Table 1). The total number of cases decreased for the second consecutive year. The 13% decline in 1982 was followed by a 6.4% decline in 1983. This decrease in cases, however, was not reported by all states. The four Mid-Atlantic states--maryland, pennsylvania, Virginia, and west virginia--and the district of columbia actually experienced an 83% increase in cases. These states and the district of columbia reported 1,903 cases in 1983 (compared with 1,040 cases in 1982) which accounted for approximately one-third (32.4%) of all rabies cases nationally.
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29/43. Nondomestic mammalian bites.

    life-threatening injuries resulting from wild animal bites are always treated first. Local wound management varies, depending on the type of wound and its location, but scrupulous cleansing and copious irrigation are mandatory. tetanus prophylaxis and rabies prophylaxis are provided according to accepted guidelines. antibiotic prophylaxis is not routinely necessary but is advisable for wounds of the hands or joints and for wounds in immunocompromised individuals.
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30/43. Monoclonal antibodies as a tool for rabies epidemiological studies.

    Hybridoma-produced monoclonal antibodies specific of antigenic determinants of the nucleocapsid and the glycoprotein of rabies virus showed differences between fixed and street strains of rabies virus. Standard panels of monoclonal antibodies allowed us to determine the geographic origin of imported cases of rabies in animals and humans.
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