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Microbiology case study Spring 2009 Case Study On July 14th, a 26 year-old man developed severe nausea and bloody emesis. At a local hospital emergency room, he was treated with IV fluids and antiemetic medication and admitted for further observation. That evening he became disoriented, combative, and had difficulty breathing. On July 16th, he became hypotensive and hypoxic and was transferred to a specialty care facility for ventilator support. Examination revealed a temperature of 104 F (40 C), unequal pupils, copious oral secretions, scattered bilateral pulmonary crackles, and a white blood cell count (WBC) of 46. . Broad spectrum antibiotics were initiated. On July 20th, the patient developed a cardiac arrhythmia, respiratory and renal failure and died on July 21st. Three days earlier, a friend told the family that sometime around May 12th, the patient had been awakened by a bat on his right hand. He killed the bat and was bitten in the process. The patient did not seek medical attention. Investigation found in the patient’s house multiple portals of entry for bats, openings between the attic and living areas, and extensive deposits of guano in those areas. 1. What is the diagnosis? 2.
What organism caused the disease? 3. Who can get the disease? 4. How is the disease transmitted? 5. What is the course of treatment for this illness? 6. How is a person affected by the disease? 1. Rabies 2. Rhabdovirus. An RNA virus that belongs to the order Mononegavirales, viruses with a nonsegmented, negative-stranded RNA genome. Has a distinct “bullet” shape. 3. All warm blooded hosts (species of mammals), including humans, and is almost always fatal. 4. Transmission of rabies virus usually begins when infected saliva of a rabid animal host is passed to an uninfected animal.
Various routes of transmission have been documented and include contamination of mucous membranes (i. e. , eyes, nose, mouth), aerosol transmission, and corneal transplantations. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host. The best way to prevent rabies is to make sure your pets get their rabies shots and to avoid contact with wild or stray animals. 5. Rabies kills if it is not prevented. Once signs of the disease appear in an animal or a human, they usually die within 10 days. But you can get anti-rabies shots to fight off the disease.
Rabies shots need to be given as soon as possible after a bite has occurred, before symptoms appear. The combination of human rabies immune globulin (HRIG) and vaccine is recommended. The vaccination consists of a series of six shots given over 30 days. One shot is given around the area of the bite. The rest are given in the arm. Sometimes an additional shot is required the first day if they are unable to give it all around the site of the bite. The rabies shots produce an immune response which helps the body fight off the virus. The shot makes the body produce antibodies that then kill the virus. . Rabies virus infects the central nervous system, causing encephalopathy and ultimately death. The first symptoms of rabies may be nonspecific flu-like signs ??? malaise, fever, or headache, which may last for days. There may be discomfort or numbness at the site of exposure (bite), progressing within days to symptoms of cerebral dysfunction, anxiety, confusion, agitation, progressing to delirium, abnormal behavior, hallucinations, and insomnia. The acute period of disease typically ends after 2 to 10 days. Once clinical signs of rabies appear, the disease is nearly always fatal.