FRIDAY, April 20 (HealthDay News) -- An experimental treatment that saved a Wisconsin girl who did not have postexposure prophylaxis after contracting rabies in 2004 did not cure two similar children diagnosed in 2006, according to a report in the April 20 Morbidity and Mortality Weekly Report.
Researchers from the U.S. Centers for Disease Control and Prevention and colleagues analyzed the case of a 10-year-old Indiana girl hospitalized with irritability, altered mental status, slurred speech and difficulty swallowing. After confirmation of rabies, the Wisconsin protocol was initiated, including phenobarbital, midazolam, ketamine, and amantadine, and IV ribavirin. Life support was withdrawn several weeks later due to her poor prognosis.
Her mother later reported that a bat may have flown in the girl's open bedroom window several weeks earlier.
In the second case, an 11-year-old California boy who had returned from the Philippines received emergency treatment for symptoms including tachycardia, hallucinations, agitation and hydrophobia. He received ketamine and midazolam infusions, and ribavirin and enteral amantidine, tetrahydrobiopterin, and coenzyme Q10.
Life support was withdrawn on the 27th day of hospitalization due to a lack of brain activity. Siblings recalled that a dog had bit him two years before, and tests showed RNA of a Philippines canine rabies variant in his saliva.
"To consider use of the Wisconsin rabies treatment protocol, the disease must be diagnosed as early in the course as possible, which requires enhanced clinical awareness of the disease among health-care providers," according to the report. "Rabies should be included in the differential diagnosis of any unexplained acute, rapidly progressive viral encephalitis."
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