A man remains admitted to the University Hospital of Cruces in Barakaldo diagnosed with rabies as health sources have confirmed. The patient of non-Spanish nationality and whose age has not transcended was bitten by a cat in the forearm last August in Morocco according to these same sources.
The doctors have arrived at the diagnosis for the symptoms and the tests carried out so far, although the definitive confirmation will still take about four days, until the National Center of Microbiology (CNM) completes the tests that will confirm the presence of the virus in the samples taken to the sick one.
Rabies is a viral disease that affects the nervous system and is fatal in almost 100% of cases when the patient has begun to develop symptoms, which are not very high fever, changes in mood, nausea and vomiting , photophobia (intolerance to light), drooling and convulsions, among others. The most common way to get it is the bite of an animal – dog, cat, bat … – infected and the incubation period goes from a few days to a year, although the most common is about three weeks.
Despite its terrible prognosis, rabies is also preventable in all cases if adequate medical assistance is received after the bite, which consists of cleaning the wound, a rabies immunoglobulin injection and a vaccine schedule. Contagion among people is very rare, according to scientific literature.
Only about fifteen people have managed to survive rabies after developing symptoms through the so-called Milwaukee protocol, which involves inducing a coma in the patient and applying all life support measures in the ICU so that the body can cope with the infection minimizing the risk of damage to vital organs. For this, a cocktail of antiviral drugs is administered: ketamine, ribavirin and amantadine, according to sources at the Hospital de Cruces.
The patient admitted to Barakaldo shows signs of necrosis in the arm, which would reveal “a serious infection and that the wound was not well cleaned in his day.” “All this shows that the man has not received adequate medical assistance since he suffered the bite,” health sources explain.
The patient initially went to the San Eloy Hospital in Barakaldo, from where he has been transferred to the Cruces Hospital where according to sources at the center “the protocols established in these cases are being applied”.
The Ministry of Health of the Basque Government has begun to contact the environment of the affected person, but does not confirm whether it is applying the Milwaukee protocol. This was devised in 2004 by a team of doctors led by Dr. Rodney Willoughby and despite saving some lives, it fails in most of the times it is applied and has not released some survivors of severe neurological sequelae, according to these health sources.
The Basque Government insists that at the moment it is a suspicion, since the final results that will be obtained in the coming days are missing. “In any case, given that it is an imported case, the Public Health Directorate wants to make it clear that Euskadi’s domestic animals are free of rabies,” says the Health Note.
Rabies causes about 60,000 deaths a year worldwide, according to data from the World Health Organization (WHO). Most of them are due to the so-called “urban cycle” that has dogs, cats and other mammals such as ferrets as the cause of the bites that make the virus reach the human being. In these cases, unvaccinated pets contract the disease by being bitten by other infected savages.
The last outbreak in Spain of the urban cycle occurred in Malaga in 1975 and caused the death of two people. It was, after massive vaccination campaigns for dogs and cats of the 60s and 70s, the last lash of the disease. In 2014, however, a woman of Moroccan origin died in Madrid after having contracted the disease in her country, where rabies in dogs has not yet been eradicated and the disease remains endemic.
The other cycle through which rabies virus circulates is the so-called “bats”, although in this case infections are much less frequent. In Spain, two people from Huelva and Vallladolid were bitten last year by infected bats, as confirmed by tests conducted at the CNM. To avoid risks, current protocols establish anti-rabies treatment in all cases of bat bites, although the presence of the virus in the animal is not confirmed.
When the rabies virus enters a person’s organism, it begins to spread through nerve cells until it reaches the brain. The speed with which it does depends on many factors including the place of the bite, the type of wound and whether it has been cleaned or not. The virus, for example, advances faster if there are more nerve endings at the site of the bite – hands, neck, face … – or is closer to the central nervous system, according to medical sources.
The infection, however, is possible to stop if the patient receives after the exposure the dose of immunoglubin (which slows the progress) and the vaccine, which will prepare the immune system to eradicate the virus before it settles in the brain, where it multiplies exponentially and ends up causing death.