Rabies, human - Canada

Date: 15 Dec 2000 16:23:55 GMT+0200
From: ProMED-mail
Source: MMWR, 15 Dec 2000 / 49(49);1115-6 [edited]


Public Health Dispatch: Human Rabies --- Quebec, Canada, 2000
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On 22 Sep 2000, a 9-year-old boy awoke with a fever and complained of pain
in his upper left arm. The pain persisted, and he developed insomnia and
tremors in his left arm and hand. He was admitted to a local hospital on 27
Sep 2000. That evening, he had mild dysphagia, pruritus of his upper chest
and back, and a transient macular rash. On 28 Sep 2000, he developed
tremors and myoclonic jerks in both arms, had become agitated, and had
hydrophobia, aerophobia, dysarthria, and visual hallucinations. The next
day hypersalivation was observed and the tremors and myoclonus had spread
to his lower extremities. He became very anxious, indicated that he was
suffocating, and underwent endotracheal intubation. A diagnosis of rabies
was considered and he was transferred to a children's hospital. Laboratory
findings were normal except a mildly elevated cerebral spinal fluid
protein. An electroencephalogram indicated no epileptiform activity. Head
magnetic resonance imaging was normal. On 29 Sep 2000, the results of the
rabies tests were positive, and rabies immune globulin and vaccine were
administered to the patient. His neurologic and hemodynamic status
deteriorated, and he died on 6 Oct 2000.

A nuchal skin biopsy tested positive by direct fluorescent antibody test.
Rabies virus was isolated from the saliva, and saliva, tears, and skin
biopsy were positive for rabies by reverse transcriptase-polymerase chain
reaction. Molecular analysis of the virus revealed a rabies variant
associated with silver-haired (_Lasionycteris noctivagans_) and eastern
pipistrelle (_Pipistrellus subflavus_) bats.

During August, the patient visited a zoo and went to a day camp where he
observed bats that had been captive for many years. No history of
substantial exposure to bats or other animals occurred in these places. On
28 Aug 2000, while the patient and his brother were sleeping in a rural
cottage, his parents found a bat in the kitchen. The same evening, the
patient's brother went into the bathroom and observed a bat that seemed to
have difficulty flying. He alerted his father who removed it from the
cottage with his bare hands. Approximately 3 days later, the patient showed
his mother a 0.8-inch (2 cm) erythematous lesion with a small central
laceration on his upper left arm. No action was taken. After the diagnosis
was made, rabies postexposure prophylaxis was offered to the patient's
parents and brother. Prophylaxis also was given to 44 health-care providers
because of possible percutaneous or mucous membrane exposure to the
patient's saliva and to 12 playmates possibly exposed to the patient's
saliva. This human death from rabies was the first one reported in Canada
since 1985.

Reported by: N Turgeon, MD, M Tucci, MD, Sainte-Justine Hospital; J
Teitelbaum, MD, Maisonneuve-Rosemont Hospital; D Deshaies, MD, PA Pilon,
MD, J Carsley, MD, L Valiquette, MD, Montreal-Centre Dept of Public Health,
Montreal, Quebec. H Arruda, MD, L Alain, MSc, Ministry of Health and Social
Svcs, Quebec, Canada. AC Jackson, MD, Kingston General Hospital; A
Wandeler, PhD, Animal Diseases Research Institute, Kingston, Ontario. Viral
and Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases,
National Center for Infectious Diseases; and an EIS Officer, CDC.

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