Published Date: 2012-02-08 15:07:46
Subject: PRO/AH/EDR> Rabies - Italy (03): Mantova ex India, human, fatal, corr.
Archive Number: 20120208.1036461

RABIES - ITALY (03): MANTOVA ex INDIA, HUMAN, FATAL, CORRECTION
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[1]
Date: Wed 8 Feb 2012
From: Paola De Benedictis <pdebenedictis@izsvenezie.it> [edited]


The patient in Mantova survived 17 days from the beginning of coma (Glasgow Coma Score of 3) and 4 weeks from the initial clinical signs. He was admitted to the hospital on 23 Oct 2011 and not on 3 Oct 2011, as posted. Thus, the incubation period of about 4 weeks fits perfectly with the case.

We were surprised, realizing that the mail posted yesterday [7 Feb 2012] did not correspond to what we had sent the day before (see attached document), thus causing a matter of debate. We would be grateful if you could check the previous posts and make the necessary amendments.

With regards to the type of administered vaccine, it was a purified duck embryo vaccine, produced locally (in India). As mentioned in the previous post, no passive immunity was administered, and we suppose this was a crucial gap, taking into account the number and severity of the wounds the patient received.

--
Luigi Gaetti MD
Azienda Ospedaliera "Carlo Poma," Mantova, Italy

Paola De Benedictis, DVM
Istituto Zooprofilattico Sperimentale delle Venezie, Padova, Italy
<pdebenedictis@izsvenezie.it>

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[2]
Date: Wed 8 Feb 2012
From: Steven Van Gucht <Steven.VanGucht@wiv-isp.be> [edited]


Contaminated saliva drops which reach the olfactory epithelium might indeed be an efficient mode of transmission to the brain. At least we know this works efficiently in our mouse models with laboratory rabies virus strains. Ingestion normally requires very high doses of virus, and this seems less likely to me.

--
Steven Van Gutch
Head of Scientific Service
Viral Diseases - Communicable and Infectious Diseases
Rue Engelandstraat 642 - 1180 Brussels
Wetenschappelijk Instituut Volksgezondheid
Institut Scientifique de Sante Publique
Scientific Institute of Public Health
http://www.wiv-isp.be
<Steven.VanGucht@wiv-isp.be>

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[3]
Date: Wed 8 Feb 2012
From: Merritt Clifton <anmlpepl@whidbey.com> [edited]


"Apparently, there is a 5-day incubation period despite the fact that the patient was bitten in the left arm and leg, sites which are relatively distant from the brain."

As the blood stream runs, these sites are relatively distant from the brain, but if the dog's 1st bite to the left leg caused the victim to fall, and the victim then lifted his left arm to protect his face, with the rabid dog lunging toward him, he might have inhaled or ingested the dog's saliva.

--
Merritt Clifton
Editor, ANIMAL PEOPLE
P.O. Box 960
Clinton, WA 98236
<anmlpepl@whidbey.com>

[ProMED-mail thanks these contributors for their responses to the RFI. ProMED-mail apologises for what may have been our error in transcribing the original report from Drs Gaetti and De Benedictis. Nonetheless, other aspects of the report have stimulated some interesting discussion. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1BIF.]

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