Public Health Dispatch:Human Rabies --- Québec, Canada, 2000
On September 22, 2000, a 9-year-old boy awoke with a fever and complained of
pain in his upper left arm. The pain persisted, and he developed insomnia and tremors in
his left arm and hand. He was admitted to a local hospital on September 27. That evening,
he had mild dysphagia, pruritus of his upper chest and back, and a transient macular
rash. On September 28, he developed tremors and myoclonic jerks in both arms, had
become agitated, and had hydrophobia, aerophobia, dysarthria, and visual hallucinations.
The next day hypersalivation was observed and the tremors and myoclonus had spread
to his lower extremities. He became very anxious, indicated that he was suffocating,
and underwent endotracheal intubation. A diagnosis of rabies was considered and he
was transferred to a children's hospital. Laboratory findings were normal except a
mildly elevated cerebral spinal fluid protein. An electroencephalogram indicated no
epileptiform activity. Head magnetic resonance imaging was normal. On September 29,
the results of the rabies tests were positive, and rabies immune globulin and vaccine
were administered to the patient. His neurologic and hemodynamic status deteriorated,
and he died on October 6.
A nuchal skin biopsy tested positive by direct fluorescent antibody test. Rabies
virus was isolated from the saliva, and saliva, tears, and skin biopsy were positive for rabies
by reverse transcriptase-polymerase chain reaction. Molecular analysis of the virus
revealed a rabies variant associated with silver-haired
(Lasionycteris noctivagans) and eastern pipistrelle
(Pipistrellus subflavus) bats.
During August, the patient visited a zoo and went to a day camp where he
observed bats that had been captive for many years. No history of substantial exposure to bats
or other animals occurred in these places. On August 28, while the patient and his
brother
were sleeping in a rural cottage, his parents found a bat in the kitchen. The same
evening, the patient's brother went into the bathroom and observed a bat that seemed to
have difficulty flying. He alerted his father who removed it from the cottage with his
bare hands. Approximately 3 days later, the patient showed his mother a 0.8-inch (2
cm) erythematous lesion with a small central laceration on his upper left arm. No action
was taken. After the diagnosis was made, rabies postexposure prophylaxis was offered
to the patient's parents and brother. Prophylaxis also was given to 44 health-care
providers because of possible percutaneous or mucous membrane exposure to the patient's
saliva and to 12 playmates possibly exposed to the patient's saliva. This human death
from rabies was the first one reported in Canada since 1985.
Reported by: N Turgeon, MD, M Tucci, MD, Sainte-Justine Hospital; J Teitelbaum,
MD, Maisonneuve-Rosemont Hospital; D Deshaies, MD, PA Pilon, MD, J Carsley, MD, L
Valiquette, MD, Montréal-Centre Dept of Public Health, Montréal, Québec. H Arruda, MD, L Alain,
MSc, Ministry of Health and Social Svcs, Québec, Canada. AC Jackson, MD, Kingston
General Hospital; A Wandeler, PhD, Animal Diseases Research Institute, Kingston, Ontario. Viral
and Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases, National Center for
Infectious Diseases; and an EIS Officer, CDC.
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