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 Vol. 14 No. 4, October 2005
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AAP Grand Rounds 14:42-43 (2005)
© 2005 American Academy of Pediatrics

CRITICAL CARE

Treatment of Rabies with Induced Coma

Source: Willoughby RE, Tieves KS, Hoffman GM, et al. Survival after treatment of rabies with induction of coma. N Engl J Med. 2005;352:2508–2514.[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.

The authors, from the Medical College of Milwaukee, Wisconsin, report a case of rabies in a previously well 15-year-old girl who rescued and released a bat but sustained a 5-mm laceration to her left index finger. The wound was washed with peroxide and no medical attention sought. One month later, she developed nausea and vomiting, followed by a partial sixth nerve palsy and ataxia. Her symptoms progressed until she was semi-obtunded. At that time, the potential diagnosis of rabies was made. The physicians consulted with the Centers for Disease Control and Prevention (CDC). Her work-up included cerebrospinal fluid testing for virus-specific antibody. The virus was not detected in skin or saliva samples.

After consultation with the family, an aggressive strategy (including antiviral therapy) was developed to prevent excitatory injury, with the hope of improving long-term patient survival. The child was treated with {gamma}-aminobutyric acid (GABA) agonists (barbiturates and high-dose . . . [Full Text of this Article]

Susan L. Bratton, MD, MPH, FAAP
Pediatric Critical Care, Primary Children’s Medical Center, University of Utah, Salt Lake City, UT

 





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