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Fatal human rabies due to Duvenhage virus from a bat in Kenya: failure of treatment with coma-induction, ketamine, and antiviral drugs.

van Thiel PP, de Bie RM, Eftimov F, Tepaske R, Zaaijer HL, van Doornum GJ, Schutten M, Osterhaus AD, Majoie CB, Aronica E, Fehlner-Gardiner C, Wandeler AI, Kager PA - PLoS Negl Trop Dis (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.p.vanthiel@amc.uva.nl

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Rabies, encephalitis caused by lyssaviruses, was considered universally fatal until a young, unvaccinated patient with bat rabies survived after a new therapeutic approach... We report on a patient with rabies due to Duvenhage virus from a bat in Kenya... Treatment with intravenous immunoglobulin 0.4 g/kg/d for 5 days as for GBS and with acyclovir 10 mg/kg three times per day iv for 5 days as for herpes simplex encephalitis was started (PCR for herpes simplex virus and varicella zoster virus in serum and CSF proved negative)... Also, there was diffuse swelling of both hemispheres... Magnetic resonance angiography did not reveal vascular abnormalities... Brainstem reflexes and deep tendon reflexes were absent... Introduction of a tube to clean the airways did not result in a response of coughing and there was no spontaneous respiration... She died on day 20 of admission, 45 days after the incident with the bat... At postmortem examination no gross abnormalities were found, apart from the pneumonia... For the detection of the virus, polyclonal rabbit anti-rabies-nucleoprotein antibody (RNP; 1∶500, Centre of Expertise for Rabies, Ottawa, Canada) was used... This 15-year-old patient was diagnosed with encephalitis... She did not receive rabies immunoglobulin or rabies vaccine... It was suggested that infection by an attenuated variant bat rabies virus or early presence of rabies antibodies in serum and CSF could have contributed to the success ,,... As mentioned, this patient differs from the non-surviving patients because of the early administration of vaccine and presence of antibodies... Details and follow-up results are awaited.

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MRI brain on day 16 of admission (4 days before death).Axial T-2 weighted images in a patient with rabies due to Duvenhage virus infection, at day 17 after admission show increased signal in the posterior part of the medulla oblongata (arrow) and in the basal ganglia (arrows).
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pntd-0000428-g002: MRI brain on day 16 of admission (4 days before death).Axial T-2 weighted images in a patient with rabies due to Duvenhage virus infection, at day 17 after admission show increased signal in the posterior part of the medulla oblongata (arrow) and in the basal ganglia (arrows).

Mentions: MRI abnormalities of the medulla oblongata had increased and now extended to mesencephalon and both dentate nuclei in the cerebellum (Figure 2). Also, there was diffuse swelling of both hemispheres. Magnetic resonance angiography did not reveal vascular abnormalities. There was no response to pain or acoustic stimuli after withdrawal of ketamine. Brainstem reflexes and deep tendon reflexes were absent. Introduction of a tube to clean the airways did not result in a response of coughing and there was no spontaneous respiration. In agreement with the wishes of the family it was decided to stop ventilatory support. She died on day 20 of admission, 45 days after the incident with the bat.


Fatal human rabies due to Duvenhage virus from a bat in Kenya: failure of treatment with coma-induction, ketamine, and antiviral drugs.

van Thiel PP, de Bie RM, Eftimov F, Tepaske R, Zaaijer HL, van Doornum GJ, Schutten M, Osterhaus AD, Majoie CB, Aronica E, Fehlner-Gardiner C, Wandeler AI, Kager PA - PLoS Negl Trop Dis (2009)

MRI brain on day 16 of admission (4 days before death).Axial T-2 weighted images in a patient with rabies due to Duvenhage virus infection, at day 17 after admission show increased signal in the posterior part of the medulla oblongata (arrow) and in the basal ganglia (arrows).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710506&req=5

pntd-0000428-g002: MRI brain on day 16 of admission (4 days before death).Axial T-2 weighted images in a patient with rabies due to Duvenhage virus infection, at day 17 after admission show increased signal in the posterior part of the medulla oblongata (arrow) and in the basal ganglia (arrows).
Mentions: MRI abnormalities of the medulla oblongata had increased and now extended to mesencephalon and both dentate nuclei in the cerebellum (Figure 2). Also, there was diffuse swelling of both hemispheres. Magnetic resonance angiography did not reveal vascular abnormalities. There was no response to pain or acoustic stimuli after withdrawal of ketamine. Brainstem reflexes and deep tendon reflexes were absent. Introduction of a tube to clean the airways did not result in a response of coughing and there was no spontaneous respiration. In agreement with the wishes of the family it was decided to stop ventilatory support. She died on day 20 of admission, 45 days after the incident with the bat.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.p.vanthiel@amc.uva.nl

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Rabies, encephalitis caused by lyssaviruses, was considered universally fatal until a young, unvaccinated patient with bat rabies survived after a new therapeutic approach... We report on a patient with rabies due to Duvenhage virus from a bat in Kenya... Treatment with intravenous immunoglobulin 0.4 g/kg/d for 5 days as for GBS and with acyclovir 10 mg/kg three times per day iv for 5 days as for herpes simplex encephalitis was started (PCR for herpes simplex virus and varicella zoster virus in serum and CSF proved negative)... Also, there was diffuse swelling of both hemispheres... Magnetic resonance angiography did not reveal vascular abnormalities... Brainstem reflexes and deep tendon reflexes were absent... Introduction of a tube to clean the airways did not result in a response of coughing and there was no spontaneous respiration... She died on day 20 of admission, 45 days after the incident with the bat... At postmortem examination no gross abnormalities were found, apart from the pneumonia... For the detection of the virus, polyclonal rabbit anti-rabies-nucleoprotein antibody (RNP; 1∶500, Centre of Expertise for Rabies, Ottawa, Canada) was used... This 15-year-old patient was diagnosed with encephalitis... She did not receive rabies immunoglobulin or rabies vaccine... It was suggested that infection by an attenuated variant bat rabies virus or early presence of rabies antibodies in serum and CSF could have contributed to the success ,,... As mentioned, this patient differs from the non-surviving patients because of the early administration of vaccine and presence of antibodies... Details and follow-up results are awaited.

Show MeSH
Related in: MedlinePlus