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Background: Myriad infectious and noninfectious causes of encephalomyelitis (EM) have similar clinical manifestations, presenting serious challenges to diagnosis and treatment. Metabolomics of cerebrospinal fluid (CSF) was explored as a method of differentiating among neurological diseases causing EM using a single CSF sample. Methodology/Principal findings: 1H NMR metabolomics was applied to CSF samples from 27 patients with a laboratory-confirmed disease, including Lyme disease or West Nile Virus meningoencephalitis, multiple sclerosis, rabies, or Histoplasma meningitis, and 25 controls. Cluster analyses distinguished samples by infection status and moderately by pathogen, with shared and differentiating metabolite patterns observed among diseases. CART analysis predicted infection status with 100% sensitivity and 93% specificity. Conclusions/Significance: These preliminary results suggest the potential utility of CSF metabolomics as a rapid screening test to enhance diagnostic accuracies and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Administration of rabies vaccine or rabies immune globulin (RIG) during symptomatic rabies is ineffective, and there are concerns about the phenomenon of “early death” reported in animals that develop rabies after receipt of rabies vaccine or immune globulin. Survival analyses of the original animal data confirm these findings in two species, whereas analyses of human case reports and the Milwaukee Protocol registry suggest lower risk of “early death” in humans. There may be a deleterious interaction of rabies vaccine and RIG with bat rabies in humans. Animal studies of bat rabies virus with bat-origin vaccines and RIG are urgently needed. [Copyright &y& Elsevier]

A letter to the editor is presented offering a follow up to a case where a 15-year-old girl survived rabies.

Rabies is the deadliest viral infection known, with no reliable treatment, and although it is entirely preventable, rabies continues to kill more than 60,000 people every year, mostly children in countries where dog rabies is endemic. America is only 1 generation away from the time when rabies killed more than 10,000 animals and 50 Americans every year, but 3 to 5 Americans continue to die annually from rabies. Distressingly, > 50,000 Americans undergo rabies prevention therapy every year after exposure to potentially rabid animals. While enormous progress has been made, more must be done to defeat this ancient but persistent, fatal zoonosis. In the US, lack of public awareness and ambivalence are the greatest dangers imposed by rabies, resulting in unnecessary exposures, anxiety, and risk. Veterinarians have a special role in informing and reassuring the public about prevention and protection from rabies. This summary of current facts and future advances about rabies will assist veterinarians in informing their clients about the disease. [ABSTRACT FROM AUTHOR]

We report the survival of a 15-year-old girl in whom clinical rabies developed one month after she was bitten by a bat. Treatment included induction of coma while a native immune response matured; rabies vaccine was not administered. The patient was treated with ketamine, midazolam, ribavirin, and amantadine. Probable drug-related toxic effects included hemolysis, pancreatitis, acidosis, and hepatotoxicity. Lumbar puncture after eight days showed an increased level of rabies antibody, and sedation was tapered. Paresis and sensory denervation then resolved. The patient was removed from isolation after 31 days and discharged to her home after 76 days. At nearly five months after her initial hospitalization, she was alert and communicative, but with choreoathetosis, dysarthria, and an unsteady gait. N Engl J Med 2005;352:2508-14. [ABSTRACT FROM AUTHOR]

In this first report of rabies in Equatorial Guinea, problems accompanying the application of the Milwaukee Protocol are described. With its apparent success, and despite a subsequent death from complications of malnutrition, we sound a note of optimism that canine as well as bat rabies may be treatable. [ABSTRACT FROM AUTHOR]