Case report: isolation of a European bat lyssavirus type 2a from a fatal human case of rabies encephalitis.
A 55-year-old bat conservationist was admitted to Ninewells Hospital, Dundee, Scotland, on November 11, 2002, with an acute haematemesis. He gave a 5-day history of pain and paraesthesia in the left arm, followed by increasing weakness of his limbs with evidence of an evolving encephalitis with cerebellar involvement. The patient had never been vaccinated against rabies and did not receive postexposure treatment. Using a hemi-nested reverse transcriptase-polymerase chain reaction (RT-PCR), saliva samples taken intravitam from different dates proved positive for rabies. A 400-bp region of the nucleoprotein gene was sequenced for confirmation and identified a strain of European bat lyssavirus (EBLV) type 2a. The diagnosis was confirmed using the fluorescent antibody test (FAT) and by RT-PCR on three brain samples (cerebellum, medulla, and hippocampus) taken at autopsy. In addition, a mouse inoculation test (MIT) was performed. Between 13 and 17 days postinfection, clinical signs of a rabies-like illness had developed in all five inoculated mice. Brain smears from each infected animal were positive by the FAT and viable virus was isolated. This fatal incident is only the second confirmed case of an EBLV type-2 infection in a human after exposure to bats.
Fooks
Anthony R
AR
Rabies Research and Diagnostic Group, Veterinary Laboratories Agency (Weybridge) [WHO Collaborating Centre for the Characterisation of Rabies and Rabies-Related Viruses], Surrey, United Kingdom. t.fooks@vla.defra.gsi.gov.uk
McElhinney
Lorraine M
LM
Pounder
Derrick J
DJ
Finnegan
Christopher J
CJ
Mansfield
Karen
K
Johnson
Nicholas
N
Brookes
Sharon M
SM
Parsons
Graham
G
White
Kathleen
K
McIntyre
Paul G
PG
Nathwani
Dilip
D
D000818:Animals; D001733:Bites and Stings; D002685:Chiroptera / Q000821:virology*; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000821:virology*; D017809:Fatal Outcome; D006801:Humans; D018114:Lyssavirus / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D011818:Rabies / Q000175:diagnosis / Q000821:virology*; D018353:Rhabdoviridae Infections / Q000175:diagnosis / Q000821:virology*