Friday, September 20, 2013

Creepy Rabies Case

Last year, I wrote about the latest rabies surveillance numbers in the U.S.  I had noted that the number of feline rabies cases had increased in 2010.  I don’t have the numbers from 2011, but I do have the latest report for 2012, and I’m happy to see that the number of cases of feline rabies (257 cases) is less than what was reported in 2010 (303 cases).  The rest of the report wasn’t very interesting, except for the last section, where they described a case of human rabies from February of this year. 

In February, a man was presented to an emergency room in Maryland for pain in his right hip.  He developed encephalitis and hypersalivation soon after admission, and died after 22 days of hospitalization.  Five days before he died, samples were obtained and submitted to the CDC, and rabies was confirmed.  The virus was analyzed, and was shown to be a variant associated with raccoons.  During the patient investigation, no known exposure to animals was elicited from the patient history.  However, the patient had received a kidney transplant from a deceased donor approximately 17 months before the onset of rabies.
That donor had presented to an emergency department in Florida in August of 2011 with signs of nausea, vomiting, and decreased sensation in his upper extremities. He developed seizures and an altered mental status that required sedation and intubation.  He was declared brain-dead 17 days after the signs began.  The patient had a history of consuming raw fish, and the presumed diagnosis at the time of death was severe acute gastroenteritis.  Organs were harvested from the donor and transplanted into... four people!   

Dramatization of what the operation probably looked like.

They tested other organs from that donor that were stored in the organ bank, and a diagnosis of rabies was confirmed. Analysis of the virus from that donor and from the Maryland recipient showed the virus to be identical.  They investigated further and discovered that the donor was an active hunter and raccoon trapper.  

The 3 remaining organ recipients were identified and were given post-exposure prophylactic treatment and have so far remained healthy. 


The moral of the story:  don’t hunt raccoons.

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