Cases reported "Rabies"

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1/9. Rabies: otolaryngologic manifestations.

    Rabies is a rare, fatal viral infection, usually transmitted by the bite of an infected animal. Some 30,000 Americans are immunized annually, however, so public health considerations are common. The development of a new vaccine, grown in human diploid cell culture, is discussed. It appears to have high antigenicity with no serious morbidity. A case of a patient with fatal rabies who had fever, delirium, dysphagia, and cervical and pectoral subcutaneous emphysema is presented.
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2/9. Case report: rapid ante-mortem diagnosis of a human case of rabies imported into the UK from the philippines.

    The United Kingdom is free from rabies, with the last human death from indigenous rabies recorded in 1902. However, between 1946 and 2000, 20 deaths were reported in the United Kingdom in people who were bitten and infected while abroad in rabies endemic areas. The rapid diagnosis of suspected human rabies cases influences the use of anti-rabies post-exposure prophylaxis for potential contacts with the victim. In addition, the occurrence of a human rabies case requires urgent investigation to support patient management policies. In May 2001, a case of human rabies imported into the United Kingdom from the philippines was identified. A 55-year-old man was admitted to University College Hospital, london, with clinical symptoms and a history consistent with exposure to rabies. saliva, cerebrospinal fluid), and skin biopsies (from the wound site and nape of the neck) were submitted for conventional ante-mortem diagnostic techniques. Established diagnostic techniques, including the fluorescent antibody test (FAT), mouse inoculation test, (MIT) and the rabies tissue culture inoculation test (RTCIT), failed to detect the virus. In contrast, hemi-nested reverse transcription-polymerase chain reaction (RT-PCR), followed by automated sequencing confirmed the presence of classical rabies virus (genotype 1) in both the saliva and skin specimens within 36 hr of sample submission. Subsequent phylogenetic analysis demonstrated that this isolate was closely related to that of canine variants currently circulating in the philippines.
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3/9. Rabies encephalomyelitis: clinical, neuroradiological, and pathological findings in 4 transplant recipients.

    BACKGROUND: Three patients received solid organ transplants from a common donor and were subsequently discharged from the hospital following an uneventful hospital course. Within 30 days, all 3 organ recipients returned to the hospital with varying symptoms that progressed to rapid neurological deterioration, coma, and death. OBJECTIVE: To describe the clinical, neuroradiological, and pathological findings of rabies virus infection in organ transplant recipients infected from a common donor. DESIGN: Case series involving a common donor and 3 organ recipients ascertained through review of clinical course and autopsy findings. A fourth case was determined by review of pending autopsy cases in which death occurred within the same time interval. Portions of postmortem central nervous system and organ tissues were frozen and formalin-fixed. Fluids and tissues were also collected for cultures, serology, and molecular studies. Postmortem fluids and tissues and antemortem fluids and tissues from all 4 transplant recipients and serum and banked lymphocyte or spleen cells from the donors were sent to the Centers for Disease Control and Prevention for further evaluation. SETTING: Transplant unit of an urban teaching hospital. RESULTS: Antemortem cerebrospinal fluid analysis for 3 of the 4 recipients was consistent with a viral etiology. neuroimaging and electroencephalogram studies were suggestive of an infectious encephalitis or a toxic encephalopathy. Initial laboratory testing did not demonstrate an infectious etiology. Postmortem histologic analysis, immunohistochemistry, electron microscopy, and direct fluorescence antibody testing revealed rabies virus infection. Serological testing done postmortem confirmed rabies virus infection in the common donor. CONCLUSIONS: These cases demonstrate a risk for transmitting rabies virus infection through solid organ and tissue transplantation, and this diagnosis should be considered in any rapidly progressing neurological disease.
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4/9. 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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5/9. Naturally acquired rabies in an eastern chipmunk (Tamias striatus).

    Rabies in an Eastern chipmunk was detected by fluorescent-antibody testing and mouse inoculation. The results were independently confirmed, and the virus was recovered from tissue culture.
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6/9. Treatment of patients bitten by rabid or suspected rabid wolves with inactivated tissue culture rabies vaccine and rabies gammaglobulin.

    During 1972-1976 46 persons in 9 foci were bitten by wolves. 39 of them were immunized with antirabies gammaglobulin and tissue culture rabies vaccine; 7 received culture vaccine only. Rabies in wolves was confirmed clinically or in the laboratory in 8 foci. Bites of dangerous localization: face, head or fingers of the hands, predominantly multiple, were noted in 25 humans; 5 of them were young, 7 to 16 years old. Antirabies gammaglobulin was given to 9 people, predominantly in the dose of 0,5 ml per kg of weight, once on the 1st day after exposure (381-538 IU per kg of weight) to 14 people, once on the 2nd day (706-773 IU) to 3 people, twice on the 2nd and 3rd to 3 people, once on the 3rd and 5th day to 10 people, twice on the 2nd and 3rd day or on the 5th day after exposure. vaccination course was started 24 hours after administration of gammaglobulin and predominantly in the dose of 5 ml; it lasted for 25 days and was followed by 3 booster injections on the 10th, 20th and 30th day. Titres of virus neutralizing antibody were tested in dynamics in 39 people immunized with gammaglobulin and tissue culture vaccine. Antirabies gammaglobulin induced some inhibitory effect, but 2-3 booster injections of the tissue culture rabies vaccine completely compensated this effect. During the observation period of 10 months to 5 years all the exposed people remained healthy.
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7/9. 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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8/9. Failure of postexposure treatment of rabies in children.

    Five failures of postexposure treatment of rabies in small children with multiple severe bites on the face and head are discussed. All had received rabies immune globulin and a potent tissue-culture vaccine. However, not all wounds had been infiltrated with immune globulin. Surgical closure prior to wound injection with immune globulin was performed in three cases. Another patient had wounds sutured after an intramuscular injection of immune globulin, without wound infiltration.
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9/9. Corneal impression test for the diagnosis of acute rabies encephalitis.

    PURPOSE: This study aimed to alert ophthalmologists as to their role in the diagnosis of rabies. methods: A 13-year-old girl was admitted with acute encephalitis of unknown etiology. Bacterial and viral cultures and test results for lyme disease and tuberculosis were negative. Initial cerebrospinal fluid, serum, skin, and saliva specimens were negative for rabies. A corneal impression test was performed. RESULTS: Immunofluorescent antibody staining of the epithelial cells on the corneal impression test was positive for rabies. Subsequently, the diagnosis was confirmed by serum serologic analysis and saliva testing. CONCLUSION: Ophthalmologists can assist in the diagnosis of rabies by using the corneal impression test. Corneal smears should be part of the routine antemortem work-up for presumptive rabies.
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