Survival after treatment of rabies with induction of coma.
We report the survival of a 15-year-old girl in whom clinical rabies developed one month after she was bitten by a bat. Treatment included induction of coma while a native immune response matured; rabies vaccine was not administered. The patient was treated with ketamine, midazolam, ribavirin, and amantadine. Probable drug-related toxic effects included hemolysis, pancreatitis, acidosis, and hepatotoxicity. Lumbar puncture after eight days showed an increased level of rabies antibody, and sedation was tapered. Paresis and sensory denervation then resolved. The patient was removed from isolation after 31 days and discharged to her home after 76 days. At nearly five months after her initial hospitalization, she was alert and communicative, but with choreoathetosis, dysarthria, and an unsteady gait.
Willoughby
Rodney E
RE
Department of Pediatric Infectious Diseases, Medical College of Wisconsin, Milwaukee, USA. rewillou@mail.mcw.edu
Tieves
Kelly S
KS
Hoffman
George M
GM
Ghanayem
Nancy S
NS
Amlie-Lefond
Catherine M
CM
Schwabe
Michael J
MJ
Chusid
Michael J
MJ
Rupprecht
Charles E
CE
D000293:Adolescent; D000547:Amantadine / Q000627:therapeutic use; D000777:Anesthetics / Q000627:therapeutic use*; D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D001264:Athetosis / Q000209:etiology; D001569:Benzodiazepines / Q000627:therapeutic use; D001733:Bites and Stings; D002685:Chiroptera; D002819:Chorea / Q000209:etiology; D003128:Coma / Q000139:chemically induced*; D004401:Dysarthria / Q000209:etiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use; D011818:Rabies / Q000188:drug therapy* / Q000628:therapy; D011820:Rabies virus / Q000276:immunology*; D012254:Ribavirin / Q000627:therapeutic use
D000777:Anesthetics; D000998:Antiviral Agents; D001569:Benzodiazepines; D012254:Ribavirin; D007649:Ketamine; D000547:Amantadine; D008874:Midazolam