Two people bitten by the same stray dog: different treatment measures lead to different clinical outcomes

2017年《Infectious Diseases of Poverty》期刊发表了一篇病例报告：Bites from the same dog, different outcomes for two patients: a case report，报告中The mother and son were bitten by the same stray dog, and the son received wound treatment and vaccination (Chengda Suda^®), but the mother did not receive treatment. After 3 months, the mother had rabies attack and the son was still alive after 2 years of follow-up.。

The patient's course of disease

The article describes that at about 17:00 on August 25, 2012, a 31-year-old woman and her 7-year-old son were attacked by stray dogs while walking near the village. The mother was bitten on the right thigh and the son was bitten on the left calf. Then the villagers caught the stray dog, killed it and buried it. The stray dog did not undergo laboratory testing. The mother simply cleaned her son's wound with tap water. On August 26, she went to the village health station. Both of them were identified as Class III exposure. The son received the first dose of rabies vaccine on the same day and completed the whole process in the following time. Vaccination (the vaccine is freeze-dried human rabies vaccine (Vero cell) produced by Liaoning Chengda Biological Co., Ltd., with five needles), the mother did not choose to be vaccinated for economic reasons, only cleaned the wound, and neither of them was injected with immunoglobulin.

On November 20, 2012, the mother went to the County People's Hospital for persistent high fever (39 ℃), nausea, vomiting, chest tightness, agitation and other symptoms. She was diagnosed with encephalitis and received 2 days of cefoperazone, sulbactam, levofloxacin and supportive treatment such as oxygen inhalation, rehydration, and maintenance of electrolyte balance. On November 22, the patient's condition deteriorated and began to develop mild coma, salivation and black stool, and then transferred to Xuchang Central Hospital. On November 24, he was transferred to the First Affiliated Hospital of Zhengzhou University. He was diagnosed with suspected rabies and received systematic and supportive treatment. The patient's condition continued to deteriorate and he died on December 6.

Evidence of rabies infection

On November 24, 2012, the hospital reported the suspected rabies case to the Henan Provincial Center for Disease Control and Prevention (CDC). The patient's saliva, blood and cerebrospinal fluid were collected on December 4, and the patient's son's serum was collected on December 15. The sample was sent to the Henan Provincial CDC for testing. The saliva of the patient was positive for rabies virus and the cerebrospinal fluid was negative by PCR, and the titer of anti-rabies virus neutralizing antibody (RVNA) in the serum of the patient was 0.68 IU/ml by rapid fluorescence focus inhibition test (RFFIT). The patient's son's RVNA was 2.29 IU/ml, and his serum RVNA level was continuously monitored until 2 years after exposure.

Discussion of the incident

This case report documents the different results of two cases bitten by the same stray dog and takes different disposal measures, again illustrating the importance of post-exposure prophylaxis (PEP),The complete PEP content includes: ① local treatment of the wound as soon as possible; ② rabies vaccination as soon as possible; ③ when necessary, the use of rabies passive immune preparations as soon as possible. Experts believe that these three are very important.The surviving cases in this article are very lucky. Although rabies immunoglobulin was not injected, the whole process of vaccination produced protective neutralizing antibodies. At the same time, the bite site was far away from the central nervous system, and there was enough time for the body to produce antibodies. However, the author emphasizes that level III exposure should be treated with complete PEP, and the practice of non-injection madness is not worth promoting. Because rabies is a lethal disease, it can be prevented and cannot be cured. The incubation period is generally 1-3 months, and a few can be as short as two weeks. In this case, vaccination alone cannot effectively protect it. Therefore, once bitten by a crazy animal, there should be no fluke, and the complete PEP should be started immediately to minimize the risk.

As can be seen from this case report, the vaccine is an effective means of combating rabies,A large number of published cases of mad dog bites are Chengda.^®The protective effect provides direct evidence, using both immune procedures can reach or exceed the effective antibody level, continuous follow-up found no cases of rabies.In order to implement the concept of "One Health, Zero Death", Chengda Biology will continue to communicate and cooperate with multiple departments to jointly prevent and respond to rabies.

References:

[1] Huang X Y, Li X L, Wu S Y, et al. Bites from the same dog, different outcomes for two patients: a case report[J]. Infectious diseases of poverty, 2017, 6(04): 118-121.