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Rabies in the Critical Care Unit: Diagnostic and Therapeutic Approaches

Published online by Cambridge University Press:  18 February 2016

Alan C. Jackson
Alan C. Jackson*
Affiliation:
Departments of Internal Medicine (Neurology) and of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
*
Health Sciences Centre, GF-543, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada
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Abstract:

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Worldwide, human rabies is prevalent where there is endemic dog rabies, but the disease may present unexpectedly in critical care units when suggestive clinical features have passed. In North America transmission from bats is most common and there is often no history of a bat bite or even contact with bats. Laboratory diagnostic evaluation for rabies includes serology plus skin biopsy, cerebrospinal fluid, and saliva specimens for rabies virus antigen and/or RNA detection. Rare patients have survived rabies, and most received rabies vaccine prior to the onset of illness. Therapeutic coma (midazolam and phenobarbital), ketamine, and antiviral therapies (dubbed the "Milwaukee Protocol") were given to a rabies survivor, but this therapy was likely not directly responsible for the favorable outcome. There have been many subsequent failures of similar therapeutic approaches. There is no scientific rationale for the use of therapeutic coma in human rabies. New approaches to treating human rabies need to be developed.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 5 , September 2011 , pp. 689 - 695
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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