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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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Immunofluorescence tests with antirabies nucleocapside conjugate.Immunofluorescence of murine neuroblastoma cells using antirabies nucleocapside conjugate (Bio-Rad). The arrow points to cells with positive green immunofluorescence. The right picture is a magnification of the left with the scale bar.
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pntd-0000428-g004: Immunofluorescence tests with antirabies nucleocapside conjugate.Immunofluorescence of murine neuroblastoma cells using antirabies nucleocapside conjugate (Bio-Rad). The arrow points to cells with positive green immunofluorescence. The right picture is a magnification of the left with the scale bar.

Mentions: Cell culture of the various clinical samples was carried out by inoculation of murine neuroblastoma cells and BHK-21 cells propagated in 24-well microtiter plates. CSF was tested without processing, and saliva was made up to a volume of 2 mL with virus transport medium. The other specimens were ground with virus transport medium up to a volume of 5 mL. After centrifugation a volume of 200 µL was added to each well. Immunofluorescence tests with anti-rabies nucleocapside conjugate (Bio-Rad) showed immunopositivity as presented in Figure 4.


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)

Immunofluorescence tests with antirabies nucleocapside conjugate.Immunofluorescence of murine neuroblastoma cells using antirabies nucleocapside conjugate (Bio-Rad). The arrow points to cells with positive green immunofluorescence. The right picture is a magnification of the left with the scale bar.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0000428-g004: Immunofluorescence tests with antirabies nucleocapside conjugate.Immunofluorescence of murine neuroblastoma cells using antirabies nucleocapside conjugate (Bio-Rad). The arrow points to cells with positive green immunofluorescence. The right picture is a magnification of the left with the scale bar.
Mentions: Cell culture of the various clinical samples was carried out by inoculation of murine neuroblastoma cells and BHK-21 cells propagated in 24-well microtiter plates. CSF was tested without processing, and saliva was made up to a volume of 2 mL with virus transport medium. The other specimens were ground with virus transport medium up to a volume of 5 mL. After centrifugation a volume of 200 µL was added to each well. Immunofluorescence tests with anti-rabies nucleocapside conjugate (Bio-Rad) showed immunopositivity as presented in Figure 4.

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