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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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Lyssa virus phylogenetic tree with presented rabies case embedded.Phylogenetic tree of the presented rabies case (sequence arrowed) and representative Lyssavirus genomes. Mega 3.1 tree (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) based on a 367–base pair fragment in the nucleoprotein region. Bootstrap percentages higher than 75% are indicated. Genotype 1  =  rabies virus (RV); Genotype 2  =  Lagos bat virus (LBV); Genotype 3  =  Mokola virus (MV); Genotype 4  =  Duvenhage virus (DV); Genotype 5  =  European bat lyssavirus (EBLV) 1a and 1b; Genotype 6  =  European bat lyssavirus (EBVL) 2a and 2b; Genotype 7  =  Australian bat lyssavirus (ABLV). Present virus isolate in Genotype 4: DV E2007011420 (arrowed).
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pntd-0000428-g005: Lyssa virus phylogenetic tree with presented rabies case embedded.Phylogenetic tree of the presented rabies case (sequence arrowed) and representative Lyssavirus genomes. Mega 3.1 tree (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) based on a 367–base pair fragment in the nucleoprotein region. Bootstrap percentages higher than 75% are indicated. Genotype 1  =  rabies virus (RV); Genotype 2  =  Lagos bat virus (LBV); Genotype 3  =  Mokola virus (MV); Genotype 4  =  Duvenhage virus (DV); Genotype 5  =  European bat lyssavirus (EBLV) 1a and 1b; Genotype 6  =  European bat lyssavirus (EBVL) 2a and 2b; Genotype 7  =  Australian bat lyssavirus (ABLV). Present virus isolate in Genotype 4: DV E2007011420 (arrowed).

Mentions: A 367–base pair fragment in the nucleoprotein region was sequenced and phylogenetic analysis was performed using Mega 3.1 (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) [11] (Figure 5).


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)

Lyssa virus phylogenetic tree with presented rabies case embedded.Phylogenetic tree of the presented rabies case (sequence arrowed) and representative Lyssavirus genomes. Mega 3.1 tree (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) based on a 367–base pair fragment in the nucleoprotein region. Bootstrap percentages higher than 75% are indicated. Genotype 1  =  rabies virus (RV); Genotype 2  =  Lagos bat virus (LBV); Genotype 3  =  Mokola virus (MV); Genotype 4  =  Duvenhage virus (DV); Genotype 5  =  European bat lyssavirus (EBLV) 1a and 1b; Genotype 6  =  European bat lyssavirus (EBVL) 2a and 2b; Genotype 7  =  Australian bat lyssavirus (ABLV). Present virus isolate in Genotype 4: DV E2007011420 (arrowed).
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0000428-g005: Lyssa virus phylogenetic tree with presented rabies case embedded.Phylogenetic tree of the presented rabies case (sequence arrowed) and representative Lyssavirus genomes. Mega 3.1 tree (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) based on a 367–base pair fragment in the nucleoprotein region. Bootstrap percentages higher than 75% are indicated. Genotype 1  =  rabies virus (RV); Genotype 2  =  Lagos bat virus (LBV); Genotype 3  =  Mokola virus (MV); Genotype 4  =  Duvenhage virus (DV); Genotype 5  =  European bat lyssavirus (EBLV) 1a and 1b; Genotype 6  =  European bat lyssavirus (EBVL) 2a and 2b; Genotype 7  =  Australian bat lyssavirus (ABLV). Present virus isolate in Genotype 4: DV E2007011420 (arrowed).
Mentions: A 367–base pair fragment in the nucleoprotein region was sequenced and phylogenetic analysis was performed using Mega 3.1 (neighbour joining, Kimura 2–parameter, 1,000 bootstrap values) [11] (Figure 5).

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