Sunday, February 5, 2012

Pediatric Rabies Patient in California Recovers

An eight year old girl with a history of paroxysmal supraventricular tachycardio (occasional rapid heart rate) was seen by her pediatrician for a sore throat and vomiting on April 25th, 2011. A week later, she was taken to the emergency department on accounts of poor oral intake and dehydration. Two days after that incident, she returned to the emergency room for non-localized abdominal pain, neck and back pain and was discharged. The next day she returned with the previous days' symptoms, a rapid pulse, respiratory distress and acidosis. All infectious disease tests were negative with the exception of a positive rhinovirus PCR. As time progressed, she suffered from ascending flaccid paralysis, a fever, and decreased level of consciousness.
This patient was tested for west nile virus and enterovirus which both came back negative. Then, the Californa Department of Public Health Viral and Rickettsial Laboratory suggested testing for rabies based on the clinical syndromes. The tests came back positive for rabies-specific antibodies IgG and IgM . She was later sedated, received advanced supportive care and was placed in therapeutic coma. She, however, was not administered rabies immunoglobin or the post-exposure rabies vaccine. (why?)
A few weeks after the combined treatments and therapeutic coma, the patient was transferred to a rehabilitation center where she regained fine motor skills as well as her cognitive skills.
A public health investigation in this rural county in California ruled possible exposure to the rabies virus through means of suspicious animal contact in school- the girl was apparently scratched by two cats in school weeks before the onset of the symptoms. Of all the cats tested, none came back positive for rabies. Nevertheless, precautions were taken and 27 people that came in contact with the girl were given post exposure prophylaxis.

-Angela Cesena


1 comment:

Annelise said...

Perhaps by the time you're experiencing neurological breakdown, it's already too late for post-exposure prophylaxis to do anything? Ie, it's supposed to prevent the disease and the girl already has it. The RIG/vaccine might interfere with the body's immune response that, as the Ig tests have show, has already been mounted.

It's really interesting that the people around her got Rabies vaccine...there haven't really been any cases of human to human transmission? Although I suppose if she was spitting on them or kissing them...