Tuesday, August 18, 2009

Surviving rabies

The best way to survive rabies - which kills 55,000 people a year worldwide - is, of course, to avoid it. The zoonotic disease is transmitted from rabid animals - most often dogs and bats - through their saliva via a bite or scratch. Jeanna Giese (pictured at age 19), is the first person known to have survived rabies without receiving vaccine beforehand (pre-exposure immunization) or afterward (post-exposure prophylaxis). She was bitten by a rabid bat in Wisconsin in 2004 and since then, two others have been saved using the same treatment involving a medically-induced coma, now known as the "Milwaukee protocol": a 15-year-old boy in Brazil, who was also bitten by a bat, and an 8-year-old Colombian girl, who had been bitten by an infected cat (and later died of unrelated causes).
The first symptoms of rabies are flu-like (fever, headache, and fatigue), followed by respiratory, gastrointestinal, and neurological signs. The disease quickly progresses to either "furious rabies," characterized by hyperactivity, or "dumb rabies," characterized by partial paralysis. In both forms, the victim becomes completely paralyzed, lapses into a coma, and dies from respiratory failure within 7 days. An unattributed video of a victim of rabies is here (caution). Some of the stranger symptoms exhibited by a 13-year-old Connecticut girl who died in 1995 are as follows: deviation of her uvula and later her tongue to the left, pharyngeal spasms, and tactile hallucinations (she complained of a sensation of insects in her mouth). In 2005, 4 transplant recipients in Texas contracted rabies from a single organ donor who had developed rapid neurological deterioration and died of a clinically unsuspected case; after the donor's kidneys, liver, and vascular tissue were transplanted, all four died within 48 hours. But the report of the case states that the estimated risk of rabies infection from solid organ transplantation is less than 1:1,000,000,000,000.

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