Rabies

Rabies (from a Latin word meaning rage) is a viral disease that causes acute encephalitis in animals and people. It can affect most species of warm-blooded animals, but is rare among non-carnivores. In unvaccinated humans, rabies is almost invariably fatal once full-blown symptoms have developed, but post-exposure vaccination can prevent symptoms from developing.

Recently publicised cases

Transmission by animal bites

Several recently publicised cases have stemmed from bats, which are known to be a vector for rabies.

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The United Kingdom, which has stringent regulations on the importation of animals, had also been believed to be entirely free from rabies until 1996 when a single Daubenton's bat was found to be infected with a rabies-like virus usually found only in bats - European Bat Lyssavirus 2 (EBL2). There were no more known cases in the British Isles until September 2002 when another Daubenton's bat tested positive for EBL2 in Lancashire. A bat conservationist who was bitten by the infected bat received post-exposure treatment and did not develop rabies.

Related Topics:
1996 - Daubenton's bat - September 2002 - Lancashire

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Then in November 2002 David McRae, a Scottish bat conservationist from Guthrie, Angus who was believed to have been bitten by a bat, became the first person to contract rabies in the United Kingdom since 1902. He died from the disease on November 24 2002.

Related Topics:
November 2002 - Guthrie - Angus - 1902 - November 24 - 2002

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In October 2004 a wild female brown bear killed one person and injured several others near the city of Brasov, Central Romania. The bear was killed by hunters and diagnosed with rabies. More than one hundred people were vaccinated afterwards.

Related Topics:
2004 - Bear - Brasov - Romania

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In November 2004, Jeanna Giese, a 15-year old girl from Fond du Lac, Wisconsin, became one of only six people known to have survived rabies after the onset of symptoms. All of the other five received vaccination before symptoms developed. Giese's disease was already too far progressed for the vaccine to help, and she was considered too weak to tolerate it. Doctors at the Children's Hospital of Wisconsin in Wauwatosa, a suburb of Milwaukee, achieved her survival with an experimental treatment that involved putting the girl into a drug-induced coma, and administering a cocktail of antiviral drugs. Giese had symptoms of full-blown rabies when she sought medical help, 37 days after being bitten by a bat. Her family did not seek treatment at the time because the bat seemed healthy. Jeanna regained her weight, strength, and coordination while in the hospital. She was released from the Children's Hospital of Wisconsin on January 1, 2005, becoming the first known instance of a person surviving rabies without vaccine treatment.

Related Topics:
2004 - Jeanna Giese - Fond du Lac - Wisconsin - Vaccination - Wauwatosa - Milwaukee - Coma - Antiviral drug - Bat - January 1 - 2005

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Transmission through organ transplants

Rabies is known to have been transmitted between humans by transplant surgery. The medical advisory web site Manbir Online notes "Under no circumstances should a cornea be transplanted from a donor, who died of an undiagnosed neurological disorder."

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Infections by corneal transplant have been reported in Thailand (2 cases), India (2 cases), Iran (2 cases), the United States (1 case), and France (1 case). The CDC documents the case in France in 1980. Details of two further cases of infection resulting from corneal transplants were described in 1996.

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In June 2004, three organ recipients died in the United States from rabies transmitted in the transplanted kidneys and liver of an infected donor from Texarkana. There are bats near the donor's home, but he did not mention having been bitten. The donor is now reported to have died of a cerebral hemorrhage, the culmination of an unidentified neurological disorder, although recipients are said to have been told the cause of death had been a car crash. Marijuana and cocaine were found in the donor's urine at the time of his death, according to a report in The New England Journal of Medicine. The surgeons

Related Topics:
2004 - United States - Texarkana

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"thought he had suffered a fatal crack-cocaine overdose, which can produce symptoms similar to those of rabies. 'We had an explanation for his condition,' says Dr. Goran Klintmalm, a surgeon who oversees transplantation at Baylor University Medical Center, where the transplants occurred. 'He'd recently smoked crack cocaine. He'd hemorrhaged around the brain. He'd died. That was all we needed to know.' ... Because of doctor-patient confidentiality rules, doctors involved with this case would not talk about it on the record, but a few did say that had not had cocaine in his blood, the E.R. doctors might have investigated his symptoms more aggressively instead of assuming he had overdosed. (Because no autopsy was done, doctors have not been able to establish whether the rabies or the drugs actually killed him.)" (The New York Times Magazine, July 10, 2005)

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In February 2005, three German patients in Mainz and Heidelberg were diagnosed with rabies after receiving various organs and cornea transplants from a female donor. Two of the infected people died. Three other patients who received organs from the woman have not yet shown rabies symptoms. The 26 year old donor had died of heart failure in December 2004 after consuming cocaine and ecstasy. In October 2004, she had visited India, one of the countries worst affected by rabies world-wide. Dozens of medical staff were vaccinated against rabies in the two hospitals as a precautionary measure.

Related Topics:
2005 - German - Mainz - Heidelberg - Cocaine - Ecstasy - India

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Associated Press reports that "Donated organs are never tested for rabies. The strain detected in the victims' bodies is one commonly found in bats, health officials said." According to CNN "Rabies tests are not routine donor screening tests, Virginia McBride, public health organ donation specialist with the Health Resources and Services Administration, said. The number of tests is limited because doctors have only about six hours from the time a patient is declared brain-dead until the transplantation must begin for the organs to maintain viability."

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