segunda-feira, 12 de março de 2012


A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

Date: Wed 7 Mar 2012
Source: NE 10 [in Portuguese, trans. Mod.TY, edited]

The Ceara Central Laboratorio (LACEN) confirmed the diagnosis of rabies in a 9 year old boy, interned in the Sao Vicente de Paulo Maternity Hospital in the Barbalha municipality, in interior Ceara state. The director of the hospital says that they are awaiting a 2nd confirmation test, which wil be done in Sao Paulo. "This 2nd confirmation will be considered official by the Ministry of Health," the director said.

The samples for the test were sent on Wednesday 7 [Mar 2012] to Sao Paulo, according to the coordinator of health promotion and protection of the Ceara Secretariat of Health (SESA), Manoel Fonseca. "We await results of the test in Sao Paulo this weekend," said the coordinator.

The boy, interned in the hospital, remains in a coma induced by the treatment indicated by the Ministry of Health, known as the Recife Protocol [a version of the Milwaukee protocol].

According to Fonseca, only one medication that is part of the protocol of Recife, has not yet been given. This is because the medicine is only passed on by the Health Ministry after confirming the diagnosis of human rabies with [both of] the 2 tests. "When the test results come in from Sao Paulo confirming the diagnosis, the Ministry passes the drug directly to the
hospital, not from or through the state Secretariat," said the coordinator.

Without this drug, Fonseca said that the treatment is ineffective. "The treatment followed here in the state is as if the test was already positive. Even though this drug has not yet been given, it does not change the ineffective [part of] treatment regimen," he confirmed. This view is also shared by the hospital director, Ernani de Freitas. "The doctor who is overseeing the case has confirmed that due to the induced coma, the drug may be administered after a few days without harming the treatment," said Ernani.

Neither the coordinator nor the hospital director gave the name of the drug, according to them, for safety and to avoid self-medication by the people. According to the Ministry of Health, the treatment bears the name of the capital of Pernambuco state and is the model to be followed for treatment of human rabies cases in Brazil. This was adopted by the Ministry after a 16 year old adolescent was cured [of clinical rabies] in 2008 in the Oswaldo
Cruz Hospital in Recife, which is why it has the name of the city [see proMED-mail archive no. 20090919.3292].

The treatment has cured 2 patients in the world. The 1st case of cure [survival] was registered in 2004 in the city of Milwaukee in the USA.

The boy was admitted to hospital with symptoms of fever, vomiting and restlessness. The 1st suspicion [of rabies] was when he had meningitis, but the diagnosis changed when the family stated that the boy had been bitten by a marmoset [tamarin] on 3 Feb [2012] in an area where the family lives, in the Jati municipality. According to Manoel Fonseca, the boy did not tell the family that he had been bitten.

In Ceara state, 2 rabies cases were registered in 2010. A 10 year old boy in Ipu municipality and a 26 year old farmer in Chaval municipality died due to the disease.

[byline: Leonardo Heffer]

communicated by:

[There has been a previous case of rabies involving transmission to a human by a tamarin in Ceara [see ProMED-mail archive no. 20080212.0565], but these animals have rarely found to be hosts of rabies virus. It will be interesting to learn if the confirmatory test is positive,
if the drug is administered, and what the outcome of the case turns out to be.

A HealthMap/POroMED-mail interactive map showing the location of Ceara state can be accessed at . - Mod.TY

Between 2001 and 2011, 140 cases of human rabies were reported in Brazil, the last cases in 2010: 3 cases (2 cases in Ceara state, 1 case in Rio Grande do Norte). - Mod.RNA]

[see also:
Rabies, bovine - Brazil: (PA) 20120223.1050775 Rabies, human, bovine - Mexico, Brazil 20120123.1018767
Rabies - Brazil (04): (PE), recovery 20090919.3292
Rabies, human, monkey - Brazil: (Ceara) 20080212.0565]

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