Rabid Bat Rabies Warning
Case
Last September a California man died from rabies about 6
weeks after being bitten by a bat. The bat bit him on the right index finger
while he was in bed. After being bitten, the man washed the wound but did not
seek medical attention.
Five weeks later, he began to develop symptoms of rabies. In spite of medical
treatment, the man died a week later.
Prevention
How could this man's death have been prevented?
Anyone bitten by a potentially rabid animal should
immediately disinfect the wound (the man did wash the bite), capture the animal
safely (the man did catch the bat but let it fly away), contact both the local
health department and be seen right away by a physician to determine whether
rabies PEP treatment is
needed. (PEP is postexposure prophylaxis.) In this case, when the man finally
did seek medical attention, it was too late.
Barbara K. Hecht,
Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com
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Human Death Associated with Bat Rabies --- California, 2003
Rabies is a rapidly progressive, incurable viral encephalitis that is, with
rare exception, transmitted by the bite of an infected mammal. On September 14,
2003, a previously healthy man aged 66 years who resided in Trinity County,
California, died from rabies approximately 6 weeks after being bitten by a bat.
This report summarizes the investigation by the Trinity and Shasta County Health
Departments and the California Department of Health Services (CDHS). Persons
should avoid direct contact with bats; however, if such contact occurs, the
exposed person should visit a health-care provider immediately, and the exposure
should be reported to local public health officials.
In September 2003, the patient was admitted to a
hospital emergency department (ED) for assessment of atypical chest pain. He had
a 2-week history of mild, nonspecific complaints (e.g., drowsiness, chronic
headache, and malaise), a 5-day history of progressive right arm pain and
paresthesias, and a 1-day history of right-hand weakness. The arm pain was
severe enough to wake him from sleep and progressively worsened. He also
described a sharp pain radiating bilaterally up the right arm to his axilla and
left chest. The pain was relieved by administering nitroglycerin in the ED. The
patient reported being bitten by a bat on the right index finger while in his
bed approximately 5 weeks before admission. He removed the bat from his home,
and it flew away. The patient washed the wound but did not seek rabies
postexposure prophylaxis (PEP) at that time. Because the patient reported to the
ED at an early stage of rabies infection, with predominantly local symptoms near
the bite site, rabies vaccine, rabies immune globulin, ribavirin, and interferon-alpha were administered on the
day of admission; a second dose of rabies vaccine was administered 3 days later.
On admission, he was afebrile, alert, and oriented but
had decreased right upper extremity strength, decreased sensation to light touch, and slight
impairment in his ability to concentrate. His white blood cell (WBC) count was
elevated at 13,900 cells/µL (normal: 3,700--9,400 cells/µL). All other
laboratory values were within the normal range.
The patient had steady neurologic decline during the following week with
confusion and disorientation. He became febrile on the fourth hospital day and
was intubated for airway protection. Electromyography of his right and left
upper extremities indicated distal demyelinating polyneuropathy. By the fifth
hospital day, he had a right lung infiltrate, and his electroencephalogram showed diffuse
slowing. Two days later, he died. Four family members and two of
40 health-care workers involved in the patient's treatment received rabies PEP
as a precautionary measure. The patient's wife received PEP because she had been
asleep in the same bed as the patient when the bat bit him and possibly had been
exposed to the same bat.
Antemortem specimens were sent to the Viral and
Rickettsial Disease Laboratory (VRDL) at CDHS and to CDC for evaluation. The
specimens included multiple saliva and serum samples, nuchal skin biopsy, urine, and spinal fluid.
Postmortem corneal impressions also were obtained. A nested, reverse
transcription polymerase chain reaction assay
performed on saliva samples was positive for evidence of rabies virus nucleic acid. Sequence analysis
demonstrated 100% homology with a rabies virus variant associated with the
silver-haired bat (Lasionycteris noctivagans).
Reported by: A Deckert, MD, Shasta County Public Health,
Redding; C Glaser, MD, Viral and Rickettsial Disease Laboratory; B Sun, DVM, Div
of Communicable Disease Control, California Dept of Health Svcs. Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases; L Demma, PhD, EIS Officer,
CDC.
Editorial Note:
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