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RABIES - GERMANY (HAMBURG) EX MOROCCO
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Thu 19 Apr 2007
From: Christian Drosten <drosten@bni-hamburg.de>
Rabies, Human, Germany (Hamburg) ex Morocco
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A 55-year-old man was referred to the University Medical Centre of
Hamburg, Germany, on Wednesday, 18 Apr 2007. He presented with fever,
nausea, paresthesias of the left hand, headache and difficulty
swallowing. His pet dog had been involved in a fight with a stray dog
in Moroccos 6 weeks previously, and he had been bitten in his left
hand when separating the fighting dogs.
Medical consultation was sought right after the injury, but no
vaccination was initiated. His 15-year-old dog was euthanized by a
veterinarian 4 weeks later, due to inability to stand up.
Rabies was 1st suspected in the beginning of the week by a local
hospital, which the patient consulted for fever and paresthesia. On
admission in Hamburg, RT-PCR for rabies virus nucleocapsid RNA in 2
different saliva samples and one corneal swab was positive. The
amplicon sequence showed 99 percent nucleic acid identity with a
genotype 1 rabies virus from Morocco. All other phylogenetic
neighbors stemmed from Morocco or Algeria.
The patient had received active and passive post exposure vaccination
in the local hospital on Tuesday [17 Apr 2007]. Deep sedation with
ketamine and midazolam was initiated on Thursday [19 Apr 2007].
Amantadine but no other antiviral drugs have been given.
Decision-making on further treatment is ongoing.
--
Christian Drosten & Stephan Schmiedel, Marcus Panning, Gerd Burchard,
Christian Gerloff, Ansgar Lohse
University of Hamburg Medical Centre & Bernhard Nocht Institute for
Tropical Medicine
Hamburg, Germany
<drosten@bni-hamburg.de>
[ProMED-mail thanks Dr Drosten for providing this report prior to its
general release. We hope that the patient will to respond to the
delayed post-exposure treatment. Visitors to Morocco should be made
aware of the continuing risk of exposure to canine rabies in that
country. - Mod.CP]
[see also:
2004
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Rabies, human, canine - Morocco (04) 20041009.2764
Rabies, human, canine - Morocco (03) 20040912.2540
Rabies, human, canine - Morocco (02) 20040911.2525
Rabies, human, canine - Morocco 20040909.2512
Rabies, canine - France ex Morocco (03) 20040905.2480
Rabies, canine - France ex Morocco (02) 20040902.2445
Rabies, canine - France ex Morocco 20040829.2411
Rabies, canine - France ex Morocco: OIE 20040726.2047
1997
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Rabies, dog - Switzerland ex Morocco (03) 19971125.2368
Rabies, dog - Morocco: emergency [repeat] (02) 19971112.2293
Rabies, dog - Morocco: emergency [repeat] 19971112.2286
Rabies, dog - Switzerland ex Morocco: Emergency 19971102.2236]
........................cp/msp/dk
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