Minas investigates suspected human rabies death; victim was an indigenous teenager

The state has not confirmed death from the viral disease for 10 years, which has a lethality rate of approximately 100%.

A suspected death of human rabies in Minas Gerais put the State Health Department (SES) on alert. This is because the virus is classified as deadly, as it kills practically 100% of infected people.

The suspected case is a 12-year-old indigenous teenager who lived in Bertópolis, in the Jequitinhonha Valley region. The boy was reportedly bitten by a bat about 10 days ago and, on the 3rd, he was admitted to a hospital in Teófilo Otoni.

The SES informed, by note, that it was notified of the death on Monday (4). Since then, it has adopted several security measures so that, if the disease is confirmed as the cause of death, the virus does not make more victims in the state.

In Minas, the last human rabies death was in 2012, and it happened in Rio Casca. Regarding the recent suspicion, the folder stressed that the case is still under analysis.

“It is important to clarify that the case is under investigation, that is, it has not yet been confirmed by laboratory tests. The patient’s biological samples have already been collected and will be forwarded to reference laboratories,” he said.

Even without the diagnosis concluded, the SES notified the suspected case to the Ministry of Health. In addition, it is actively searching for people who have had contact with the suspected case and referring them to prophylactic medical care.

It also intensified the rabies vaccination of dogs and cats in the region.

Check out all the measures that are being followed below:

  • Notification of the suspected case to the Ministry of Health;
  • Guidance on the collection of biological samples;
  • Request to send a preliminary investigation report;
  • Investigation in the location where the exposure occurred with an active search for people who had contact with the suspected case and referral for prophylactic medical care;
  • Contact the Instituto Mineiro de Agropecuária for appropriate actions;
  • Rabies vaccination of dogs and cats in the locality – focal block;
  • Dissemination of the case in the region with the aim of alerting people about the forms of transmission and prevention of rabies.

See below information from the Ministry of Health on rabies:

How is rabies transmitted?
Rabies is transmitted to humans through the saliva of infected animals, mainly by biting, and can also be transmitted by scratching and/or licking these animals.

The incubation period varies between species, from days to years, with an average of 45 days in humans, and may be shorter in children. The incubation period is related to the location, extent and depth of the bite, scratch, lick or type of contact with the infected animal’s saliva; the proximity of the gateway to the brain and nerve trunks; concentration of inoculated viral particles and viral strain.

In dogs and cats, shedding of virus by saliva occurs 2 to 5 days before the appearance of clinical signs and persists throughout the course of the disease (period of transmissibility). The death of the animal occurs, on average, between 5 and 7 days after the presentation of symptoms.

The period of transmissibility of the virus in wild animals is not known for sure. However, it is known that bats (bats) can harbor the virus for a long period, without apparent symptoms.

What are the symptoms of rabies?
After the incubation period, nonspecific clinical signs and symptoms of rabies appear, which last an average of 2 to 10 days. During this period, the patient has:

– general malaise;
– small temperature rise;
– anorexia;
– headache;
– nausea;
– sore throat;
– numbness;
– irritability;
– restlessness;
– feeling of anguish.
– Lymphadenopathy, hyperesthesia and paresthesia may occur in the path of peripheral nerves, close to the bite site, and behavioral changes.

What are the complications of anger?
Rabies infection progresses, with more serious and complicated manifestations, such as:

– increasing anxiety and hyperexcitability;
– fever;
– delusions;
– involuntary, generalized muscle spasms and/or convulsions.
– Spasms of the muscles of the larynx, pharynx and tongue occur when the patient sees or tries to ingest liquid, presenting intense drooling (“hydrophobia”).
– Muscle spasms progress to paralysis, leading to cardiorespiratory changes, urinary retention and intestinal constipation. It is also observed the presence of dysphagia, aerophobia, hyperacusis and photophobia.

IMPORTANT: The patient remains conscious, with a period of hallucinations, until the installation of a comatose condition and evolution to death. The period of evolution of the clinical picture, from the onset of signs and symptoms until death, is, in general, 2 to 7 days.

How is rabies diagnosed?
Laboratory confirmation in life, that is, the diagnosis of human rabies cases, can be performed by the direct immunofluorescence method, in corneal impression, scraping of the lingual mucosa or by skin biopsy of the cervical region (bulbar tissue of hair follicles) .

The sensitivity of these tests is limited and, when negative, the possibility of infection cannot be excluded. An autopsy is extremely important for diagnostic confirmation.

differential diagnosis

There are no difficulties in establishing the diagnosis when the clinical picture is accompanied by signs and symptoms characteristic of rabies, preceded by a bite, scratch or lick of mucous membranes caused by a rabid or suspected animal. This typical clinical picture occurs in about 80% of patients.

In the case of human rabies transmitted by vampire bats, whose form is predominantly paralytic, the diagnosis is uncertain and the suspicion falls on other diseases that can be confused with human rabies. In these cases, the differential diagnosis should be performed with: tetanus; Guillain-Barré syndrome, pasteurellosis, from cat and dog bites; infection by virus B (Herpesvirus simiae), by monkey bite; botulism and rat-bite fever (Sodóku); cat-scratch fever (benign inoculation lymphoreticulosis); post-vaccination encephalitis; psychiatric conditions; other viral encephalitis, especially those caused by other rhabdoviruses; and tularemia.

It is worth noting the occurrence of other arbovirus encephalitis and mercury poisoning, especially in the Amazon region, with encephalitis compatible with rabies. It is important to emphasize that the patient’s anamnesis must be carried out with the companion and be well documented, with emphasis on non-specific symptoms, epidemiological and vaccination history. In the physical examination, in the face of clinical suspicion, carefully observe the facies, presence of hyperacusis, hyperosmia, photophobia, aerophobia, hydrophobia, reports of sore throat, difficulty in swallowing, pain in the lower limbs, and changes in behavior.

How is rabies treated?
Rabies is an almost always fatal disease, for which the best prevention measure is pre- or post-exposure vaccination. When anti-rabies prophylaxis does not occur and the disease sets in, a human rabies treatment protocol can be used, based on the induction of deep coma, use of antivirals and other specific drugs.

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