(Press-News.org) A team of French clinicians has diagnosed the first case of rabies in that country since 2003. Only 20 cases of human rabies had been diagnosed in France between 1970 and 2003. Moreover, the patient was unaware of having been bitten. So it is not surprising that that diagnosis was not suggested until day 12 post admission to the intensive care unit. The case report appeared April 8 in the Journal of Clinical Microbiology, a publication of the American Society for Microbiology.
"Rabies is nowadays extremely rare in the developed world," said Christian Brun-Buisson, head of the medical intensive care unit, and director of the Infection Control Unit, Assistance Publique Hopitaux de Paris, France. "This case had an even more disturbing clinical presentation, and no obvious exposure to an animal bite, which made us search for an array of diseases before one of our team members suggested it could be a case of imported rabies."
The patient, a 57 year old man who had lived in France for 15 years, had recently returned from a six-month stay in Mali, West Africa. He presented with a fever of close to 101, with abundant sweating, generalized pain, and a slow heartbeat, of 40 beats per minute. The case report characterized brain imaging studies as "unremarkable." The patient tested negative for Herpes simplex-1 and -2, HIV, syphilis, and epilepsy, among other conditions.
However, "two days after ICU admission, [the patient] developed bouts of hyperactivity, disorientation, and delirium with thoughts of impending death associated with persecution ideas, alternating with periods of drowsiness and returns to normal behavior when he seemed aware of his disorder and criticized it," the investigators report. "Hypersalivation was remarkable and the patient occasionally spat on ICU personnel."
Skin biopsy and salivary swabs obtained on day 13 in the ICU confirmed the diagnosis of rabies, said Brun-Buisson. The strain, which was identified by the National Reference Center for Rabies, Paris, was known to be circulating among dogs in West Africa.
The case's complexity, and the large number of tests undergone had left 158 healthcare professionals potentially exposed to the disease via the patient's bodily fluids. Following evaluations of these personnel, 52 were deemed at risk, and were vaccinated against rabies. Two of them, who had been in close contact with salivary fluids, also received rabies immunoglobulin.
Given the risk to healthcare personnel, the investigators wanted to know whether respiratory tract secretions might be an additional source of exposure when caring for patients ventilated mechanically, via endotracheal tube, who undergo repeated suction of respiratory tract secretions. They found virus in those secretions, but they were unable to grow it in mouse models, said Brun-Buisson. "Therefore our hypothesis is that viral RNA was spreading to the lower airways from the saliva rather than resulting from viral replication in the respiratory tract, itself."
"This case serves as a reminder to physicians that rabies should be considered in patients presenting with unusual neurological symptoms and coming from a geographical area where rabies is a common disease," said Brun-Buisson. "Making this diagnosis early is important, since there is a potential risk for caregivers to be contaminated if strict isolation precautions are not taken. This is obviously of utmost importance as rabies is a uniformly fatal disease." (The patient died on day 19 post-admission.)
Rabies has been known for more than 4,300. It is the deadliest infectious disease, with the widest host range of any virus, according to a Stanford University website (virus.stanford.edu/rhabdo/rhabdoviridae.html). It is also the only infectious disease that in humans can be treated by vaccination following exposure. Prompt administration of immunoglobulin can reduce mortality from 100 percent to zero.
INFORMATION:
The American Society for Microbiology is the largest single life science society, composed of over 39,000 scientists and health professionals. ASM's mission is to advance the microbiological sciences as a vehicle for understanding life processes and to apply and communicate this knowledge for the improvement of health and environmental and economic well-being worldwide.
DALLAS, April 21, 2014 -- Among black heart failure patients, moderate depression may increase the risk of heart failure patients being hospitalized or dying, according to research in the American Heart Association journal Circulation: Heart Failure.
Comparing outcomes of 747 blacks to 1,420 whites with heart failure using a patient-reported scale of depressive symptoms, researchers found:
Even moderate depressive symptoms may raise the risk of black heart failure patients being hospitalized or dying.
Blacks with levels of depressive symptoms even below the levels ...
(MEMPHIS, Tenn. - April 21, 2015) Researchers have identified a protein that offers a new focus for developing targeted therapies to tame the severe inflammation associated with multiple sclerosis (MS), colitis and other autoimmune disorders. St. Jude Children's Research Hospital scientists led the study which appears today in the scientific journal Immunity.
Investigators showed that the protein NLRP12 works in T cells to limit production of chemical messengers or cytokines that fuel inflammation. T cells are specialized white blood cells produced to eliminate specific ...
The Energy Department's National Renewable Energy Laboratory (NREL) has released an updated proposal that will establish an international quality standard for photovoltaic (PV) module manufacturing. The document is intended for immediate use by PV manufacturers when producing modules on an industrial scale so they can increase investor, utility, and consumer confidence in PV system performance.
"Our recent research on 50,000 systems found that, during the time period we studied, just 0.1% of all PV systems were affected by damaged or underperforming modules and less than ...
A recent randomized trial that looked at the feasibility of 2013 guidelines issued by the American College of Surgeons Trauma Quality Improvement Project for trauma resuscitation found that delivering universal donor plasma to massively hemorrhaging patients can be accomplished consistently and rapidly and without excessive wastage in high volume trauma centers. The plasma is given in addition to red blood cell transfusions to optimize treatment.
The 2013 guidelines recommend that universal donor products be immediately available on arrival of severely injured patients, ...
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In the April 21 issue of the journal Science Signaling, a University of Chicago-based research team describes the precise mechanism that cells in the carotid bodies use to detect oxygen levels in the blood as it flows toward the brain. The cells translate that taste test into signals, sent through the carotid sinus nerve, a branch of the glossopharyngeal ...
MADISON - Scientists today demonstrated the potential for softwoods to process more easily into pulp and paper if engineered to incorporate a key feature of hardwoods. The finding, published in this week's Proceedings of the National Academy of Sciences, could improve the economics of the pulp, paper and biofuels industries and reduce those industries' environmental impact.
"What we've shown is that it's possible to pair some of the most economically desirable traits of each wood type," says John Ralph, the Great Lakes Bioenergy Research Center's (GLBRC) plants leader ...
PHILADELPHIA -- A team of Mayo Clinic researchers has succeeded in identifying the source of cancer in patients' gastrointestinal tracts by analyzing DNA markers from tumors. The results open the possibility that doctors could one day be able to screen for cancer anywhere in the body with a noninvasive blood test or stool sample. Such tests, if they prove practical and feasible, could mean greater convenience for patients and saved lives through earlier diagnosis of cancer, especially rare and often lethal diseases such as pancreatic cancer or lung cancer.
The researchers' ...
BUFFALO, N.Y. -- A new study by two researchers in the University at Buffalo School of Social Work has shown that parents who chronically neglect their children contribute to the likelihood that they will develop aggressive and delinquent tendencies later in adolescence, and the one factor that links neglect with those behaviors appears to be poor social skills.
While child neglect can include many different aspects, the study examined two: failure to provide for a child's basic needs and a lack of adequate supervision.
Failure to provide, which includes not meeting ...
TORONTO, April 21, 2015--The vast majority of surgeons continue to recommend that women 40 years old or older with an average risk for breast cancer be screened annually for the disease, despite a 2009
U.S. Preventive Services Task Force (USPSTF) recommendation that such women be screened biennially beginning at 50 years old and continuing through age 74.
A team of researchers studying the efficacy of policy recommendations on practicing surgeons found that 88% of breast surgeons and 82% of general surgeons continue to recommend annual mammography for women with an ...
PHILADELPHIA - Liver cancer is often lethal in humans because it is diagnosed in late stages, but new work in animal models has identified a potential diagnostic biomarker of the disease and a potential way to reverse the damage done. The study will be presented at the American Association for Cancer Research (AACR) Annual Meeting 2015 in Philadelphia.
Ying Fu, PhD, of Georgetown Lombardi Comprehensive Cancer Center explains this new work:
"Hepatocellular carcinoma, the most common form of liver cancer, remains the third leading cause of cancer-related deaths worldwide ...
