New treatment saves rabies victim

From ANIMAL PEOPLE, December 2004:

MILWAUKEE–Jeanna Giese, 15, of Fond du Lac, Wisconsin,
is the sixth person on medical record to survive rabies. After
extensive rehabilitative therapy she may become the first to resume a
normal life.
Bitten by a bat she was trying to take outside on September
12, 2004, Giese did not seek medical care. She began exhibiting
rabies symptoms on October 13, and was admitted to the Children’s
Hospital of Wisconsin in Wauwatosa on October 18.
Pediatric infectious disease specialist Rodney Willoughby,
M.D., on October 19 asked her parents, John and Ann Giese, for
permission to put her into an induced coma, which might protect her
against brain damage while he attempted treatment with an
experimental four-drug combination.
“No one had really done this before, even in animals,”
Willoughby told Juliet Williams of Associated Press. “None of the
drugs are fancy. If this works, it can be done in a lot of
countries.” Willoughby did not disclose the names of the drugs,
pending publication of the data in a peer-reviewed journal.
Kept comatose for a week, Giese became the first rabies
patient ever to survive despite having never been vaccinated, either
before or after she was bitten by a rabid animal, Centers for
Disease Control & Prevent-ion rabies expert Dr. Charles Rupprecht
told Elisabeth Rosenthal of The New York Times. Her exposure was
detected much too late for the five-dose, month-long post-exposure
vaccination sequence to have been effective.

“Even if the treatment succeeds in a second patient, it is
not clear how widely it could be used in poor parts of the world,
since it requires an intensive care unit, with high technology,”
Rosenthal cautioned.
But Orange County Vector Control District research associate
Martine Jozan posted to the ProMed electronic bulletin board,
maintained by the International Society for Infectious Diseases,
that she had learned how to handle the most complex part of the
treatment, the induced coma, nearly 50 years ago in Vietnam.
“This procedure, called artificial hibernation, was
introduced in 1952 by a French Navy surgeon, Henri Laborit, who
demonstrated for the first time the use of chlorpromazine to
tranquilize patients without sedation,” wrote Jozan.
“As a first-year medical student in 1956, working as a
volunteer in a Vietnamese military hospital, I was introduced to the
use of artificial hibernation to treat patients recovering from
surgery, or undergoing severe post-traumatic shock, or suffering
from massive septicemia,” Jozan continued.
“It was believed,” Jozan said, “that induced hypothermia
would depress the defense mechanisms of the patient and inhibit, at
least for a while, the active participation of organs, thus
minimizing large expenditures of energy.
“Having lost a very close friend to rabies,” Jozan
concluded, “who was not given the possible benefit of artificial
hibernation, I find it marvelous that the procedure was resurrected
successfully to treat this recent patient.”

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