US human rabies patient refuses treatment, dies

From NPR: An 80-year-old Illinois man has died of rabies from a bat bite. It is the first human case of rabies in the state since 1954.

The exposure occurred in mid-August, when the patient awoke to find a bat on his neck. The bat was recovered and tested positive for rabies; however, the patient refused treatment according to a press release from the Illinois Department of Public Health.

[OP note: The reason for refusal is not given and I haven’t been able to find it so far. I really can’t think of a good one…]

A bat colony was subsequently discovered in the patient’s home.

About a month after exposure, the patient started to experience symptoms including neck pain, headache, difficulty controlling his arms, finger numbness and difficulty speaking. Rabies attacks the central nervous system and brain, almost inevitably causing death.

[Helen Branswell is a senior writer at STAT News covering infectious diseases and global health.]

Treatment is advised within 24 hours of exposure, as the incubation period varies widely depending on amount of virus, exposure pathway (e.g., bite or scratch), nearness of bite to central nervous system, and other factors. Human incubation is generally considered to be 30-60 days, but ranges from a week up to a year or more.

The CDC’s human treatment protocol is a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14.

[OP note – some of us may remember horror stories about 20 shots given in the stomach. Fortunately, this was largely myth!]

One of the longest human incubation periods was documented in Wuhan, China, with symptoms developing 3 years after exposure from a dog bite. Rabies is difficult to diagnose from bat bites, since the bite is often is very small and may occur painlessly. The virus is transmitted through saliva and mucus by warm-blooded mammals, and requires a skin break.

Post-onset of symptoms, vaccination is not effective. Treatment protocols such as Milwaukee and Recife have been attempted using deep sedation, antivirals, electrolyte maintenance and vasoconstriction, but most cases were poorly documented with only one patient known to survive. The protocols are not considered effective.

[Featured image Getty/iStock via CBS News.]

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