Fatal Human Rabies Caused by European Bat Lyssavirus Type 2a Infection in Scotland

eWe report a patient with an unusual initial metabolic presentation of imported human rabies who became symptomatic within 2 weeks of returning from Mali to France. This is the single case of imported human rabies identified in France within the past 11 years and the first report of viral RNA in bronchial secretions. CASE REPORTA 57-year-old male without past medical history presented to an emergency room in March 2014 because of fever and generalized pain. He had been a resident of France for the previous 15 years and had returned 2 weeks earlier following a 6-month stay in Mali. Approximately 1 month before his return to France, he underwent a right foot injury from a tree branch which eventually healed with local care.On admission, he was conscious and cooperative but appeared anxious; he had fever (38.2°C) and abundant sweating and complained of generalized pain, mostly in the lower limbs. A clean, noninflammatory wound scar was noted on the right foot. He had marked tachypnea (rate, 40 inspirations/minute) and periodic deeper inspirations. Chest examination results were unremarkable. Arterial blood gas measurements while the patient was breathing room air were as follows: pH 7.79; partial pressure of carbon dioxide (PaCO 2 ), 11 mm Hg; PaO 2 , 136 mm Hg; bicarbonates, 16 mmol/liter; and lactate, 3.7 mmol/liter. The capillary blood glucose was measured at 12 mmol/liter, and a urine dipstick revealed glycosuria (3ϩ) and ketonuria (3ϩ). Serum creatinine was at 94 mol/liter and sodium at 136 mmol/liter. Thick and thin blood smears were negative for malaria. Chest X-ray results were normal. The patient was transferred to our intensive care unit (ICU) with a presumptive diagnosis of uncontrolled diabetes and unexplained severe respiratory alkalosis. He received intravenous fluids, continuous insulin infusion, and tetanus prevention with vaccination and serotherapy. Hyperventilation, ketonuria, and metabolic abnormalities resolved within 2 days, with normalization of pH and PaCO 2 . Glycated hemoglobin was 6.5%, and the patient required no further insulin administration during his ICU stay.Two days after ICU admission, he developed bouts of hyperactivity, disorientation, and delirium with thoughts of impending death associated with persecution ideas, alternating with periods of drowsiness and returns to normal behavior when he seemed aware of his disorder and criticized it. Hypersalivation was remarkable, and the patient occasionally spat on ICU personnel. Motor weakness, deep tendon reflexes, and limb sensory perceptions were normal. The results of a computed tomography scan and magnetic resonance imaging (MRI) of the brain were unremarkable. Electroencephalogram results showed no epileptic activity. The cerebrospinal fluid (CSF) test result was normal, with a negative PCR test for herpes simplex virus 1 (HSV-1) and HSV-2. Serological tests for human immunodeficiency virus type 1 (HIV-1) and HIV-2 and HIV-1 p24 antigen were negative. Thyroid-stimulating hormone and ammonia levels were in the normal range. Syphili...

show abstract

“…(8,11). Mixed components of furious and paralytic rabies in the same patient have already been reported (12).…”

Section: Case Reportmentioning

confidence: 64%

Severe Ketoalkalosis as Initial Presentation of Imported Human Rabies in France

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The only other report of electrophysiologic study in a case of human rabies caused by European bat lyssavirus type 2a was limited [39]. The study was performed during the terminal period.…”

Section: Discussionmentioning

confidence: 99%

Difference in neuropathogenetic mechanisms in human furious and paralytic rabies

Mitrabhakdi

Shuangshoti

Wannakrairot

et al. 2005

Journal of the Neurological Sciences

View full text Add to dashboard Cite

“…In addition, bat lyssaviruses in the UK (Nathwani et al, 2003) and Australia (Hanna et al, 2000;Samaratunga et al, 1998), both of which are considered to be free of terrestrial rabies, have caused fatal disease in people.…”

Section: Introductionmentioning

confidence: 99%

Detection of polyoma and corona viruses in bats of Canada

Misra

Dumonceaux

Dubois³

et al. 2009

Journal of General Virology

View full text Add to dashboard Cite

Several instances of emerging diseases in humans appear to be caused by the spillover of viruses endemic to bats, either directly or through other animal intermediaries. The objective of this study was to detect, identify and characterize viruses in bats in the province of Manitoba and other regions of Canada. Bats were sampled from three sources: live-trapped Myotis lucifugus from Manitoba, rabies-negative Eptesicus fuscus, M. lucifugus, M. yumanensis, M. septentrionalis, M. californicus, M. evotis, Lasionycteris (L.) noctivagans and Lasiurus (Las.) cinereus, provided by the Centre of Expertise for Rabies of the Canadian Food Inspection Agency (CFIA), and L. noctivagans, Las. cinereus and Las. borealis collected from a wind farm in Manitoba. We attempted to isolate viruses from fresh tissue samples taken from trapped bats in cultured cells of bat, primate, rodent, porcine, ovine and avian origin. We also screened bat tissues by PCR using primers designed to amplify nucleic acids from members of certain families of viruses. We detected RNA of a group 1 coronavirus from M. lucifugus (3 of 31 animals) and DNA from an asyet undescribed polyomavirus from female M. lucifugus (4 of 31 animals) and M. californicus (pooled tissues from two females).

show abstract

Fatal Human Rabies Caused by European Bat Lyssavirus Type 2a Infection in Scotland

Cited by 82 publications

References 9 publications

Severe Ketoalkalosis as Initial Presentation of Imported Human Rabies in France

Severe Ketoalkalosis as Initial Presentation of Imported Human Rabies in France

Difference in neuropathogenetic mechanisms in human furious and paralytic rabies

Detection of polyoma and corona viruses in bats of Canada

Contact Info

Product

Resources

About