Question

Patient Case #1: A nine-year-old boy developed symptoms including fever, shooting limb pain, restlessness, and tremors. He continued to worsen, and while hospitalized, he presented with increased salivation, uncontrollable lower body contractions, and visual hallucinations. His breathing was extremely labored. Based on these symptoms, he was tested for rabies and given a definitive diagnosis due to the presence of antibodies to the rabies virus in his blood. A week after the onset of symptoms, he was given post-exposure prophylaxis (PEP) therapy, including both human rabies immune globulin (HRIG) and five doses of the rabies vaccine. Despite the intensive medical intervention, this boy continued to worsen and he died about six weeks after the initial bat bite. By this time, rabies virus had been isolated from his skin, saliva, and tears; and therefore, other family and medical contacts were treated with PEP therapy as well. Digging deeper into the patient’s history, physicians learned that a bat had been captured and released from the boy’s bedroom one month prior to the appearance of symptoms. He had complained about a laceration a couple days later, which was cleaned and bandaged by his mother.

Patient Case #2: A fifteen-year-old youth was attacked by a bat which bit him in several places. His wounds were immediately washed and treated with antiseptics. He was taken to the hospital for further evaluation, and within four days of the attack, he was treated with a version of PEP that included five doses of rabies vaccine but not rabies immune globulin. Over the next two weeks, he began to show early signs and symptoms of rabies, and early tests done on his blood and spinal fluid indicated antibodies to the rabies virus, but no viral antigen. The medical professionals decided to try an innovative treatment that had been effective in a similar case. They placed the boy in a medically-induced coma and administered antiviral drugs for several weeks. Three weeks after the bite, his condition was stable and he was removed from sedation. He continued to improve and was released from the hospital a month later as one of those rare cases where medical intervention was successful against rabies.

1. What was the portal of entry for the infectious agent in both patient cases?

• urinary tract

• GI tract

• respiratory tract

• skin

  2. In both cases, the incubation period for rabies infection was

• about two–three weeks.

• 7–10 days.

• about two months.

• about two days.

• 3. What is the typical mortality rate for rabies?

• Most people recover with treatment as long as it begins early after symptoms appear.

• Even if given post-exposure prophylaxis, 1 in 2 infected persons will die.

• Most immunocompetent people will survive even if they let the infection run its course.

• Rabies is considered 100% fatal once symptoms appear.

• 4. What was the source of infection in both cases?

• domestic dogs

• family members

• bats

• skunks

• 5. Which term describes this virus’s tropism (target tissue)?

• neurotropic

• enterotropic

• dermatropic

• pneumotropic

• 6. What was the crucial difference between these two patients in terms of treatment?

• Patient two was given both antibodies and viral antigens.

• They were bitten by different species of bats.

• Patient one was given five doses of the vaccine spaced out further than patient two.

• Patient one did not receive PEP therapy until after symptoms had appeared.

Answer 1

Ans- 1.(d) Skin (reason- both the patients were bitten by bat so virus entered through the bite on skin.)

Ans- 2.(a) about two-three weeks.

Ans-3. (d) Rabies is considered 100% fatal once symptoms appear.  (reason - the patient 1 died even after post-exposure prophylaxis (PEP) therapy because symptoms had started appearing in him while patient 2 was given post-exposure prophylaxis (PEP) therapy before the appearance of symptoms so he was saved.)

Ans- 4. (c) Bats

Ans- 5. (a) neurotropic ( reason - rabies virus affects nerve cells.)

Ans-6. (d) Patient one did not receive PEP therapy until after symptoms had appeared.