Unexplained rabies in three immigrants in the United States: a virologic investigation

Article Abstract:

Cases of rabies in large urban environments can usually be traced to exposure to an animal, most often a dog. In the United States, however, more and more cases seem to involve no known contact with animals. In only 4 of 10 cases in the 1980s that were not due to exposure to an animal could the cause be determined. Ignorance or fear or insignificance of the exposure may prevent detection of the source. Sometimes the patient cannot provide direct information, either because of illness or forgetfulness. Rabies viruses isolated from three deceased patients with unexplained exposure to rabies, other patients with a known source of exposure, and animals in the United States, Thailand, the Philippines, and Mexico were studied, in an attempt to discover how the patients came down with rabies. The viral isolate from each of the three deceased patients was a rabies variant with distinctive genetic characteristics. For each, identical variants were found in specimens from rabid animals obtained from or near the country in which the patient lived before immigrating to the United States. Rabies infection in these three patients did not originate in the United States but resulted from exposures in Laos, the Philippines, and Mexico. Since the three patients had lived in the United States for 4 years, 6 years, and 11 months, respectively, the findings suggest that the onset of clinical manifestations of rabies occurred after long incubation periods. It is likely that their rabies came from the bite of an animal that went unrecognized, or was otherwise forgotten. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Development and progression

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Tick-borne diseases - a growing risk

Article Abstract:

Several diseases carried by ticks exist in the U.S., including Rocky Mountain spotted fever, Lyme disease, human ehrlichiosis, and human granulocytic ehrlichiosis. Human ehrlichiosis is common in regions where the Lone Star tick is found: south central, southern, and eastern states. Human granulocytic ehrlichiosis is common in eastern states and similar to infection with Ehrlichia chaffeensis, which causes human ehrlichiosis. A 1995 retrospective investigation found a high incidence of E. chaffeensis infection in a Tennessee retirement community. This study illustrated the value of the polymerase chain reaction in diagnosing asymptomatic ehrlichiosis. However, patients with ehrlichiosis or Rocky Mountain spotted fever require early treatment. Treatment may be considered if it is spring or summer, the patient lives in a high risk region, has been exposed to ticks, and has a high fever and headache. Doxycycline may be the most effective drug for treating ehrlichiosis and Rocky Mountain spotted fever.

Care and treatment, Editorial, Tick-borne diseases, Ehrlichiosis

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Epidemiology of human rabies in the United States, 1980 to 1996

Article Abstract:

Rabies in humans is rare in the US, yet the disease may be inadequately diagnosed when humans are infected. Rabies is frequently transmitted by bites or other close contact with infected animals, and is usually fatal if prompt diagnosis and treatment is not obtained. From 1980 to 1996, 32 cases of human rabies were reported to the CDC. Twenty-five patients had no recollection of an animal bite. Analysis of tissue samples from patients revealed that 53% of cases were associated with contact with bats and 38% with contact with domestic dogs in foreign countries.

Analysis, Diagnosis, Zoonoses, Bats (Animals), Animal carriers of disease, Bats as carriers of disease

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