It's difficult to imagine a fate worse than rabies. A 65-year-old woman experienced the full horror of that disease -- and suffered a death that I wouldn't wish on my worst enemy. A new CDC case study provides the gruesome details.
The woman was traveling in India, and while she was there, she was bitten by a puppy. In the United States, that wouldn't be much of a cause for concern, given that most dogs are domesticated and vaccinated. But that's often not true in the developing world. In this case, the dog had rabies.
About six weeks later on May 3, 2017, the patient experienced pain and tingling in her right arm. The pain became severe enough for her to see an urgent care provider three days later. Quite reasonably, the medical team suspected carpal tunnel syndrome and provided her with medication appropriate for that diagnosis. Of course, it didn't work.
The next day, May 7, she went to a hospital with shortness of breath, insomnia, anxiety, and difficulty swallowing water. The hospital ran a battery of tests but discovered nothing. This medical team thought she was suffering from anxiety, another reasonable diagnosis given her symptoms. They provided her with anxiety medication and discharged her. However, upon entering her car, she experienced claustrophobia and went back to the hospital. They gave her more anxiety meds.
It's worth pausing a moment to reflect on two things. First, having scary symptoms that doctors are unable to diagnose is a frustrating and psychologically isolating experience. It is possible that, by this time, the patient knew something was very wrong with her but was unable to receive a proper diagnosis. Second, the medical teams did nothing wrong. When a sick person shows up to the hospital in the United States, "rabies" is not usually the correct answer. Even though hydrophobia (fearing water) and claustrophobia are hallmarks of rabies, they could also be explained by severe anxiety.
From Bad to Worse
On May 8, the patient's condition worsened, and she was taken by ambulance to a different hospital. Now, she was displaying a lack of coordination, which often indicates some sort of neurological problem. Doctors had reason to believe she was suffering from a blockage in a heart blood vessel, so she underwent an emergency catheterization (i.e., doctors stuck a tube in her heart). They found nothing abnormal.
By that night, the patient was agitated, combative, and gasping for air when trying to drink water. That's when the medical team learned from her husband that she had been bitten by a dog in India.
Now, it all made sense. She probably had rabies.
The next day, May 9, the woman's neurological condition continued to deteriorate. An electroencephalogram, which measures brain activity, recorded delta waves, indicative of severe brain damage. The medical team sent tissue samples to the CDC, which confirmed rabies on May 11.
Though her doctors implemented a last-ditch effort to save her life (with an experimental treatment known as the Milwaukee protocol), it was too late. The patient died on May 21.
A Lesson About Rabies
The incubation period for rabies in humans can be several weeks. It's one of the few infectious diseases in which receiving a vaccine after exposure to the virus can still prevent the disease from manifesting. But there's a limitation: The vaccine must be administered before symptoms appear. That's why, once the diagnosis of rabies was made, the medical team didn't bother treating the woman with the vaccine.
Though rabies is incredibly rare in humans, animal bites (especially those from wild animals) must be taken very seriously. This sad and terrifying story serves as a cautionary tale.
Source: Murphy J, Sifri CD, Pruitt R, et al. "Human Rabies — Virginia, 2017." MMWR 67 (5152): 1410-1414. DOI: 10.15585/mmwr.mm675152a2.
