Rabies is one of those diseases that scares the crap out of me. Once clinical symptoms start, it is essentially a death sentence. “Essentially” because there are 6 cases of survival in the medial record, but 5 of the 6 had had rabies vaccination prior to illness. A single case of survival in an unvaccinated case is on record, but only after a long period in intensive care. Now CDC is reporting an unusual case they are calling “abortive rabies.” The patient was a 17 year old girl who had multiple hospitalizations for a variety of neurologic symptoms, including severe headache, vomiting and weakness and numbness in her right arm. After diagnostic work-ups were unsuccessful in identifying the cause, a history of exposure to bats 2 months before symptom onset was revealed. She had gone on a camping trip in Texas and entered a large cave with flying bats, several of which hit her body. She wasn’t aware of any bites or scratches. She also kept pet ferrets and a dog, but all were in good health. At this point rabies was considered and tests showed she had anti-rabies antibodies, although no virus or viral antigens were detected. At that point she got a dose or rabies vaccine and a course of human rabies immune globulin.
This young woman was sick but never sick enough to require intensive care. She was discharged after a week with her symptoms resolved, but came back to the emergency room a week later complaining of recurring headache. She left before a spinal tap could be done but came back again a week later with headache and vomiting. This time a spinal tap was performed and showed increased pressure but her headaches resolved and she wasn’t admitted. She was then lost to follow-up and could not be contacted again. Her boyfriend received rabies prophylaxis.
This is a very strange report. Since no viral genetic material was detected and her clinical course was, to say the least, unusual for rabies, it remains possible this was not rabies but an agent with cross-reacting antibodies. However she had an exposure history, relevant serology and no obvious alternative diagnosis. We have very little human rabies in North America but in Asia and Africa rabies cases and hence deaths are estimated by WHO to be around 55,000 a year. It is quite plausible that “abortive rabies” occurs without being reported. Some people, for whatever reason, may mount a more timely and vigorous immune response that prevents the catastrophic effects of the disease. Once symptoms start, with the exceptions noted, the result is virtually always fatal, but there is a several week interval after being bitten or exposed to a rabid animal where post exposure prophylaxis is highly effective in preventing onset of the the disease.
So there are things we know can be done, including vaccinating animals against rabies and post exposure prophylaxis. These things work. If you want an example of things that probably don’t work (although I’ll stop short of saying it’s impossible), here’s one:
A labourer in Jharkhand, who was bitten by a street dog, killed the animal, cut out its heart and ate it to protect himself from rabies.
After the dog bit him Saturday, Chukna Ganju, 30, a resident of Dakra village, on the outskirts of Ranchi, caught hold of the animal and killed it by flinging it on stones, local media reports said Sunday.
When the dog died, he removed its heart with the help of a pair of scissors and ate it raw. The dog had bitten him several times during the course of being killed.
“Now, there will be no effect of rabies on my body,” Chukna was quoted as saying by the local media. According to him, he did not need medical help as he did the treatment by eating the heart of the dog. (New Kerala)