It turns out a bite one year can sneek up on you a year or two later... and Doctors and Emergency room people have trouble identifying it. By then it's too late..
CDC reports two cases of human rabies in 2008……
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August 15, 2009 |
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Earlier this week the CDC reported that two cases of human rabies were confirmed in the United States in 2008; one in California and another in Missouri.
California: On March 17, 2008, a 16-year-old male who had recently entered the U.S. illegally from Oaxaca, Mexico, was brought to an emergency room in Santa Barbara County, CA. His family said he had complained of a sore throat and was not eating or drinking. He was awake and alert, but agitated and crying. IV fluids were administered and the patient was discharged with a diagnosis of pharyngitis and abdominal pain. Several hours later the patient’s family brought him back to the same hospital complaining of nausea, vomiting, fever, and sore throat, however, he was now uncooperative and was observed to spit frequently. He was again given IV fluids for dehydration and was discharged with a diagnosis of viral pharyngitis, depression, and anorexia. The next day the patient experienced vomiting and shaking and then collapsed. When paramedics arrived, he was not breathing and was unresponsive. Resuscitation efforts were not successful.
After the patient’s death, the attending physician reevaluated the diagnosis and because of the exhibited hydrophobia and aggressive behavior, as well as the fact that the patient had come to the U.S. from a canine rabies enzootic region in Mexico, he considered the possibility of rabies as a cause of illness and death.
The Santa Barbara County Public Health Department and health officials in Mexico interviewed family members and friends of the patient regarding potential rabies exposures. It was learned that the patient had received two animal bites in December of 2007. Both occurred in Oaxaca, Mexico. The patient has been bitten by a dog, and in the same month, by a fox. Several others also bitten by the fox received rabies post-exposure prophylaxis (PEP), but the patient did not.
On March 21, brain tissue obtained from the patient postmortem was determined to be positive for rabies virus antigen. Viral characterization testing further determined the rabies virus variant was most closely related to those found in Mexican free-tailed bats, rather than a canine variant. Of 29 contacts and family members, 20 were deemed to be potentially exposed and received PEP.
(Source: CDC’s Morbidity and Mortality Weekly Report, July 10, 2009, Vol. 58).
Missouri: In mid-October of 2008, a 55-year-old man from Texas County was bitten on the ear by a bat. The man captured the bat and kept it for observation but, because it was still alive after a period of three days, he released it and did not seek rabies PEP. However, on November 19, he became ill and sought treatment. Unfortunately, the delay proved fatal and he died on November 30, 2008.
Tissue submitted to the CDC later confirmed the man had a rabies virus associated with the silver-haired and eastern pipistrelle bats. The man’s death was the first in the state of Missouri due to rabies since 1959
Hundreds being checked for Rabies.
Published March 17, 2013
Associated Press
Public health agencies in five states are assessing the rabies risk for hundreds of people who may have had close contact with an infected organ donor and four transplant recipients, one of whom died, officials said Saturday.
About 200 medical workers, relatives and others were assessed for potential exposure in Maryland, where the man who received an infected kidney died, state veterinarian Katherine Feldman said. She said fewer than two dozen were urged to get the rabies vaccine as a preventive measure.
In Florida, about 90 people were identified as potentially exposed, and three were offered the rabies vaccine as of Friday, state health department spokeswoman Ashley Carr said.
Illinois Department of Public Health spokeswoman Melaney Arnold said the only potential exposures there were people who worked with the patient or the transplanted organ. She said only the organ recipient is receiving rabies treatment.
Health officials in Georgia and North Carolina are also involved in the epidemiological investigation prompted by the Maryland man's death from rabies in late February, nearly 18 months after he got the kidney from a donor in Pensacola, Fla. However, officials in those states didn't respond to requests from The Associated Press about the number of people they're assessing.
Doctors in Florida didn't test the 20-year-old donor for rabies before he died in September 2011. His heart, liver and other kidney went to recipients in Florida, Georgia and Illinois. They started getting the vaccine this month, and none has had rabies symptoms. A rabies expert unconnected to the case, Dr. Rodney Willoughby of Milwaukee, said they have a strong chance of surviving since they haven't shown any symptoms.
Health officials say the virus can be spread through the infected person's saliva and mucous membranes, but human-to-human transmission is rare. The federal Centers for Disease Control and Prevention in Atlanta says there has been only one documented instance of transmission by a bite in the U.S.
Feldman said Friday that the search for potential exposure subjects in Maryland was wrapping up. She said medical workers typically take precautions, and "we don't share saliva with that many people in our day-to-day goings about."
CDC spokeswoman Melissa Dankel said investigators are still trying to learn how the transplant donor got infected with the raccoon rabies virus that was found in his brain tissue and that of the Maryland man. She said the donor was an outdoorsman who might have been bitten by a wild animal in his native North Carolina before moving to Florida and beginning training as an Air Force aviation mechanic 17 weeks before his death.
He visited a clinic at the Pensacola Naval Air Station in August 2011 for abdominal pain and vomiting and was transferred to a civilian hospital four days later, said Defense Department spokeswoman Cynthia Smith. He later developed encephalitis, a brain inflammation that can have a host of causes, including rabies, but he wasn't tested for the disease, CDC officials say.
Smith said the airman died of severe gastroenteritis — inflammation of the stomach and small intestine — complicated by dehydration, electrolyte abnormalities and seizure. The Florida Department of Health said he died of encephalitis of unknown origin.
Federal rules require organ banks to disclose any known or suspected infectious conditions that might be transmitted by donor organs. CDC officials say they don't know what information was communicated.
Federal guidelines published last year for evaluating organ donors with encephalitis urge "extreme caution" if the suspected cause is a viral pathogen, such as rabies.
Dr. Michael Green, a University of Pittsburgh professor who heads the committee that wrote the guidelines, said the guidelines hadn't been published when the Florida patient died. He also said rabies transmission through solid organ transplants is rare. There have been just two other documented instances worldwide — one in Germany and a 2004 U.S. case in which all four recipients died. The CDC says there have been eight documented instances of rabies being transmitted by transplanted corneas.
"Nonetheless, if asked whether or not I would use organs where concern for rabies was active in the potential donor, I would urge extreme caution before using organs from this person," Green said.
One of the patients who died in the 2004 case was 18-year-old Joshua Hightower, of Gilmer, Texas, after a kidney transplant. He had kidney problems since he was a child. His mother, Jennifer, said Saturday that if rabies is suspected in a transplant donor, doctors should go ahead and transplant the organs, and then give recipients the rabies vaccine.
"The word has got to get out there and something's got to change," she said. "These people, like my son, he thought the transplant was going to give him a new life and a new opportunity to move forward, and it killed him — over somebody's negligence and their plain old stupidity, and that's what it is.
Read more:
http://www.foxnews.com/health/2013/0...#ixzz2No4glrWB
Rabies a constant reminder in the news...
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This also puts a whole different perspective on cowboy camping out west - HYOH!
Originally Posted by sfdoc
