Aerophobia

ATLANTA -- Rabies prophylaxis should be initiated in people who come into contact with bats unless it can conclusively be determined that a bite did not occur, Dr. Gerald Mandell said at the annual meeting of the American College of Physicians-American Society of Internal Medicine.

This recommendation is based on a report by the Centers for Disease Control and Prevention in Atlanta of five cases of human rabies in the United States and one case in Canada--all apparently because of contact with bats. All six patients subsequently died from rabies.

The CDC noted that of the 32 human rabies cases that have occurred in the United States since 1990, 24 (74%) have been attributed to bats.

"Bats are clearly our number one problem for rabies now," said Dr. Mandell, chief of the division of infectious diseases at the University of Virginia, Charlottesville.

If a patient, such as an infant or a mentally disabled person, is unable to provide reasonable assurance that a bite did not take place, it is appropriate to begin prophylaxis if bat contact has occurred, he said.

Prophylaxis should involve cleansing the wound, applying rabies immunoglobulin around the wound, and then giving the rabies vaccine, he added.

A diagnosis of rabies should be considered in any patient with progressive encephalitis, the CDC recommended.

An immune response may not occur until late with rabies infection, so a nuchal skin biopsy, saliva, and cerebral spinal fluid should be tested to confirm a rabies diagnosis.

According to the CDC, the six rabies deaths occurred last year in California, Georgia, Minnesota, Wisconsin, and Quebec.

These were the first rabies cases reported in the United States since 1998 and the first human deaths attributable to the disease reported in Canada since 1985.

In September, a man in California tested positive for rabies after presenting with dysphagia, hypersalivation, agitation, and generalized muscle twitching. He subsequently developed renal failure and died.

The man's wife reported that a couple of months prior to the emergence of his symptoms, her husband had tried to remove a bat that had flown into their house.

Also in September, a 9-year-old boy in Quebec, who had tested positive for rabies, died after developing tremors and myoclonic jerks in both arms, hydrophobia, aerophobia, dysarthia, and visual hallucinations.

Molecular analysis of the rabies virus isolated from the saliva, tears, and skin of the boy revealed a strain of the virus associated with silver-haired and eastern pipistrelle bats.

According to family members of the patient, one month prior the boy might have had contact with a bat that had flown into a rural cottage where the family was staying.

Rabies postexposure prophylaxis was offered to the patient's immediate family, 44 healthcare workers who may have had percutaneous or mucous membrane exposure to the patient's saliva, and 12 of the patient's playmates.

In October, a man died in Georgia apparently because of exposure to rabies. The man had previously reported to coworkers that bats had flown down from his attic and landed on him while he slept. It was later discovered that the man's attic contained a colony of about 200 Mexican free-tailed bats.

The cases in Minnesota and Wisconsin also involved bats in the attic.

COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group