There are good and bad prognostic factors in rabies as reviewed in Table 2. Our case was weaning from ventilation and eye-opening was achieved but she had not shown any limb movements that may show she was in a vegetative state similar to many survived previous cases with the severe sequel.
This may be explained due to old age and dog rabies. In conclusion, even after three doses of timely active vaccination in cases of a dog bite, rabies can occur. Rabies can be effectively prevented by adequate postexposure prophylaxis after bite of a rabid animal and not miss immunoglobulin administration in blood oozing bites by community physicians.
By using the aggressive treatment approach modified Milwaukee protocol , the patient may survive from rabies. Our report along with other published reports should give more motivation to clinicians to have an intensive treatment approach and higher education to the public to have the patience to make rabies patient survival.
The authors certify that they have obtained all appropriate patient consent forms. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Special thanks to our microbiology dept. National Center for Biotechnology Information , U. J Family Med Prim Care. Published online Mar Mohd Nadeem 1 and Prasan Kumar Panda 1.
Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4. This article has been cited by other articles in PMC. Abstract Human survival after developing rabies is very scary to humanity. Keywords: Dog bite, Milwaukee protocol, postexposure prophylaxis, rabies encephalitis, rabies immunoglobulins.
Table 1 A Literature review of cases of human rabies with survival. Vaccination and RIG provided as part of management. Open in a separate window. Case Report A year-old woman from Bijnor, Uttar Pradesh North-India with no significant past illness, medication history, or travel history presented with 5-days duration of acute onset fever that was high grade, continuous, associated with headache, and nonbilious vomiting. Figure 1. Discussion We report an old-aged woman who presented in the encephalitic state after 20 days of a street rabid dog bite of category Table 2 A literature review of factors associated with good and bad prognosis in rabies.
Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments Special thanks to our microbiology dept.
References 1. Do not kill the animal with a blow or a shot to the head, as the resulting injuries may make it difficult to perform laboratory tests to determine whether the animal has rabies. Tell your doctor that you have captured the animal that bit you. Your doctor may then contact the local health department to determine what to do with the animal. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis At the time a potentially rabid animal bites you, there's no way to know whether the animal has transmitted the rabies virus to you. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Rabies. Centers for Disease Control and Prevention. Rabies is an ever present virus; found on all continents except for Antarctica , rabies kills over 55, people each year.
The vaccine can be administered at two different times: given pre or post rabies exposure. People who are at a high risk of encountering rabies or rabid animals, such as veterinarians or laboratory workers, should receive the pre-exposure vaccine as a preventative measure. Post-exposure vaccination is recommended for all persons, even those previously vaccinated, who have come into contact with suspected rabid animals.
But, in order for the post-exposure vaccine to work, it must be administered before the onset of symptoms. If not, an infected person is expected to live only seven days after the appearance of symptoms. Rabies is transmitted through contact with the saliva of an infected animal.
On September 12, , Jeanna was bitten on the left-index finger by a rabid bat she tried to rescue at her church. Her mother proceeded to wash her wound which is advised by WHO but did not know that her daughter needed to be vaccinated. Thus, once Jeanna began exhibiting symptoms, her fate was sealed in the eyes of the medical world. At first, rabies induces flu-like symptoms such as weakness, fever, headache, and overall discomfort.
Jeanna became extremely fatigued on October 13 and by the next day was experiencing double vision. The infamous Rabies symptoms - excessive salivation, hydrophobia the fear of water due to difficulty swallowing , hallucinations, agitation - typically appear " just days before death.
A skin sample from her neck was analyzed by the CDC and tested positive for Rabies. Jeanna's future was grim. Luckily for Jeanna, his readings inspired a radical new idea to take hold in his mind. He determined that Rabies neither kills by " destroying neurons or causing inflammation in the brain ," but instead, causes excitotoxicity, which overstimulates the brain and causes the cells to die.
Jeanna's survival was a matter of time; her brain had to be protected before Rabies infiltrated it. Willoughby assembled a team of experts to discuss his theorized treatment plan, which later became known as the Milwaukee Protocol. The idea of inducing a coma left doctors wrestling with the possible side effects. Even if they did save her life would Jeanna be left severely disabled once she woke up?
The difficult decision was left to her parents who agreed to proceed with the never-before tested protocol. Experts say the shots are only effective if given very soon after exposure.
The American Society for the Prevention of Cruelty to Animals says there are few cases of people getting rabies from feral cats. In previous deaths from rabies, and the two other cases in which people survived, the rabies came from bats.
Doctors treated her with a regimen called the Milwaukee Protocol. It includes antiviral medications and a medically-induced coma to let the brain rest. It was the same regimen used to successfully treat a year-old Wisconsin girl who had rabies in Despite its past success, doctors never expected Precious to leave the pediatric intensive care unit.
She left that unit after two weeks, and is currently recovering in a general pediatric unit at the hospital.
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