Rabies - Brazil (03) : (Pernambuco), Recovery from Rabies using the Wisconsin Protocol

RABIES - BRAZIL (03): (PERNAMBUCO), RECOVERY
********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: 12 Feb 2009
From: Gustavo Trindade Henriques Filho

[In response to a ProMED inquiry about the status of the Pernambuco,
Brazil, surviving rabies patient, the following was received from Dr.
Henriquez Filho, the attending physician. - Mod.TY]

Our patient is alive. He was discharged from the critical care unit
last Wednesday (4 Feb [2009]). He is conscious, but with motor
limitations. He is conscious and speaking, with a good cognitive function.

Gustavo Trindade Henriques Filho, MD
Critical Care Unit of Infectious Diseases,
Oswaldo Cruz University Hospital
Pernambuco State University
Brazil


[This patient was treated following the Wisconsin protocol, and
represents a 2nd survival after the development of clinical disease
following treatment using the the Wisconsin protocol. ProMED thanks
Dr. Henriques Filho for this report, and will be interested in future
information about the patient's progress. The details relating to
this case and the original one in Wisconsin, as well as the
discussion it engendered concerning the efficacy of the Wisconsin
protocol in survival of rabies patients, can be found in the ProMED
archives listed below. - Mod.TY]

Rabies - Brazil (02) : (Goias) .. Wisconsin treatment - additional information

RABIES - BRAZIL (02): (GOIAS)
*****************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Thu 29 Jan 2009
From: Michael Donnenberg

Regarding the Brazilian boy who died despite treatment with the
"Wisconsin Protocol," this brings to at least 3 the numbers of
patients who received this treatment and died. Two were reported in
MMWR [CDC Morbidity and Mortality Weekly Report]. Thus far, only the
original patient survived and it should be noted that the virus was
never recovered from that patient. Thus, it may well be that her
remarkable recovery was due to infection with a defective virus
rather than the treatment. It would be very helpful if the readership
could post additional cases in which the protocol was attempted.

Michael S Donnenberg, MD
Professor of Medicine
Associate Chairman for Research, Department of Medicine
University of Maryland School of Medicine
20 Penn Street, HSF2 S403D
Baltimore, MD 21201
USA


[In fact, the Pernambuco, Brazil case is still alive following
the Wisconsin protocol. - Mod.MPP]

[ProMED-mail thanks Dr Donnenberg for his comments, which were
prompted by the report in ProMED-mail archive no. 20090128.0394
posted 28 Jan 2009.

If the virus was significantly defective, it would not have
replicated at all. Unfortunately, rabies virus RNA was not detectable
by reverse transcriptase polymerase chain reaction assay in samples
taken from the Wisconsin patient, so the rabies virus variant was not
identified in this case (see ProMED-mail archive no. 20041223.3390).
Nor was the rabies virus isolated so that tests for relative
neurovirulence were not possible either.

The Wisconsin patient developed very high titers of rabies antibody in
blood and cerebral spinal fluid, which makes one wonder if she mounted
an unusually vigorous and rapid antibody response to her infection,
that resulted in her clearing the virus quickly that contributed to
her survival. Comments would be welcome from others who have employed
the Wisconsin protocol, especially Dr RE Willoughby and colleagues who
treated the surviving US patient. - Mod.TY].

Rabies, Human, Bat - Brazil (Goias)

RABIES, HUMAN, BAT - BRAZIL (03): (GOIAS)
***************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Thu 18 Dec 2008
Source: Globo.com [Portuguese, trans. Mod.TY, edited]


This Thursday [18 Dec 2008], the Health Secretariat in the Federal
District confirmed a case of human rabies in a child 9 years of age
hospitalized for 3 weeks in the Base Hospital. The disease was
confirmed by laboratory tests.

The boy is from Goias state and had been bitten by a bat in that
state. He was brought to the hospital in Brasilia, and his condition
was considered serious. He is in an induced coma in the pediatric ICU
and is undergoing a treatment developed by U.S. doctors.

According to Dr Antezana Disney, Secretary of Health Monitoring in
the DF, the hospitalization of the child does not bring risks of
transmission of the disease.

The Department of Health does not have numbers of human rabies cases
attended to in other states, only those cases of rabies contracted in
the DF; there is only one record from 1978. At the time, the person
died.

--
Communicated by:
ProMED-PORT

[It will be interesting to see whether the patient survives, and, if
so, without serious neurological sequelae. A previous case in October
2008 (see ProMED archive no. 20081122.3689) did survive and was
treated according to the Wisconsin protocol that was developed to
treat a rabies case in Wisconsin, USA, who also survived (see ProMED
archive no 20041231.3459).

A map of Brazil showing the location of Goias state and the Federal
district can be accessed at
.
A HealthMAP/ProMED interactive map of Brazil can be accessed at
.
- Mod.TY]

submitted in the interests of improved public health by: Walter M Woolf, V.M.D. Air Animal Pet Movers .