FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:2508-2514 June 16, 2005 Number 24 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Video Editorial by Jackson, A. C. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

SUMMARY

We report the survival of a 15-year-old girl in whom clinical rabies developed one month after she was bitten by a bat. Treatment included induction of coma while a native immune response matured; rabies vaccine was not administered. The patient was treated with ketamine, midazolam, ribavirin, and amantadine. Probable drug-related toxic effects included hemolysis, pancreatitis, acidosis, and hepatotoxicity. Lumbar puncture after eight days showed an increased level of rabies antibody, and sedation was tapered. Paresis and sensory denervation then resolved. The patient was removed from isolation after 31 days and discharged to her home after 76 days. At nearly five months after her initial hospitalization, she was alert and communicative, but with choreoathetosis, dysarthria, and an unsteady gait.

Source Information

From the Departments of Pediatric Infectious Diseases (R.E.W., M.J.C.), Pediatric Critical Care Medicine (K.S.T., N.S.G.), Pediatric Anesthesiology (G.M.H.), and Pediatric Neurology (C.M.A.-L., M.J.S.), Medical College of Wisconsin, Milwaukee; and the Centers for Disease Control and Prevention, Atlanta (C.E.R.).

A related video is available at www.nejm.org

Address reprint requests to Dr. Willoughby at the Department of Pediatric Infectious Diseases, 8701 Watertown Plank Rd., Midwest Athletes against Childhood Cancer Fund Research Center, Suite 3019, Milwaukee, WI 53226, or at rewillou{at}mail.mcw.edu.

Full Text of this Article

Related Letters:

Survival after Treatment of Rabies
Hemachudha T., Wilde H., Willoughby R. E. Jr., Rupprecht C. E.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1068-1069, Sep 8, 2005. Correspondence

This article has been cited by other articles:

• Castel, G., Chteoui, M., Caignard, G., Prehaud, C., Mehouas, S., Real, E., Jallet, C., Jacob, Y., Ruigrok, R. W. H., Tordo, N. (2009). Peptides That Mimic the Amino-Terminal End of the Rabies Virus Phosphoprotein Have Antiviral Activity. J. Virol. 83: 10808-10820 [Abstract] [Full Text]  
• Wang, X., Werner, B. G., Konomi, R., Hennigan, D., Fadden, D., Caten, E., Soliva, S., DeMaria, A. (2009). ANIMAL RABIES IN MASSACHUSETTS, 1985-2006. J Wildl Dis 45: 375-387 [Abstract] [Full Text]  
• (2009). Rabies. Red Book 2009: 552-559 [Full Text]  
• Schiff, D., Barton, L. L. (2008). Rabies: Beware of Bats!. AAP Grand Rounds 20: 5-5 [Full Text]  
• (2008). Human Rabies--Alberta, Canada, 2007. JAMA 299: 2740-2742 [Full Text]  
• Lafon, M., Megret, F., Meuth, S. G., Simon, O., Velandia Romero, M. L., Lafage, M., Chen, L., Alexopoulou, L., Flavell, R. A., Prehaud, C., Wiendl, H. (2008). Detrimental Contribution of the Immuno-Inhibitor B7-H1 to Rabies Virus Encephalitis. J. Immunol. 180: 7506-7515 [Abstract] [Full Text]  
• McDermid, R. C. MD, Saxinger, L. MD, Lee, B. MD, Johnstone, J. MD, Gibney, R.T. N. MD, Johnson, M. MD MHSc, Bagshaw, S. M. MD MSc (2008). Human rabies encephalitis following bat exposure: failure of therapeutic coma. CMAJ 178: 557-561 [Full Text]  
• Haider, S. MD (2008). Rabies: old disease, new challenges. CMAJ 178: 562-563 [Full Text]  
• Tuffereau, C., Schmidt, K., Langevin, C., Lafay, F., Dechant, G., Koltzenburg, M. (2007). The Rabies Virus Glycoprotein Receptor p75NTR Is Not Essential for Rabies Virus Infection. J. Virol. 81: 13622-13630 [Abstract] [Full Text]  
• Watson, N. F., Woo, D., Doherty, M. J., Frohman, E. M., Racke, M. K., De Baets, M., Hartung, H.-P., Kieseier, B. C., Stuve, O. (2007). Humoral Immune Responses After Rabies Infection. Arch Neurol 64: 1355-1356 [Full Text]  
• Hu, W. T., Willoughby, R. E. Jr., Dhonau, H., Mack, K. J. (2007). Long-Term Follow-up after Treatment of Rabies by Induction of Coma. NEJM 357: 945-946 [Full Text]  
• (2007). Human Rabies--Indiana and California, 2006. JAMA 297: 2340-2343 [Full Text]  
• Roy, A., Phares, T. W., Koprowski, H., Hooper, D. C. (2007). Failure To Open the Blood-Brain Barrier and Deliver Immune Effectors to Central Nervous System Tissues Leads to the Lethal Outcome of Silver-Haired Bat Rabies Virus Infection. J. Virol. 81: 1110-1118 [Abstract] [Full Text]  
• Weli, S. C., Scott, C. A., Ward, C. A., Jackson, A. C. (2006). Rabies virus infection of primary neuronal cultures and adult mice: failure to demonstrate evidence of excitotoxicity.. J. Virol. 80: 10270-10273 [Abstract] [Full Text]  
• Mani, C. S., Murray, D. L. (2006). Rabies. Pediatr. Rev. 27: 129-136 [Full Text]  
• Bartlett, J. G. (2006). Update in Infectious Diseases. ANN INTERN MED 144: 49-56 [Full Text]  
• Johnson, D. (2005). Rare rabies survival: Girl survives thanks to experimental treatment built on fundamentals of medicine. AAP News 26: 16-16 [Full Text]  
• Bratton, S. L. (2005). Treatment of Rabies with Induced Coma. AAP Grand Rounds 14: 42-43 [Full Text]  
• Hemachudha, T., Wilde, H., Willoughby, R. E. Jr., Rupprecht, C. E. (2005). Survival after Treatment of Rabies. NEJM 353: 1068-1069 [Full Text]  
• Solomon, T., Marston, D., Mallewa, M., Felton, T., Shaw, S., McElhinney, L. M, Das, K., Mansfield, K., Wainwright, J., Kwong, G. N. M., Fooks, A. R (2005). Paralytic rabies after a two week holiday in India. BMJ 331: 501-503 [Full Text]  
• (2005). Novel Treatment of Rabies with Induction of Coma: A Case Report. JWatch Pediatrics 2005: 6-6 [Full Text]  
• (2005). Survival of a Rabies Patient Without Active or Passive Immunization: How?. JWatch Infect. Diseases 2005: 2-2 [Full Text]  
• Tonks, A. (2005). What's new in the other general journals. BMJ 330: 1469-1470 [Full Text]  
• Jackson, A. C. (2005). Recovery from Rabies. NEJM 352: 2549-2550 [Full Text]