ABSTRACT
A 45-year-old woman from Mendoza, Argentina, was severely bitten by a dog that died 4 days later. Before death, the dog was nervous, aggressive, and had occasional seizures. Ten days after the woman had been bitten, rabies vaccine treatment was begun: 14 daily doses of suckling mouse brain vaccine followed by 2 booster doses. Twenty-one days after the biting episode, she developed a cerebellar striatal syndrome, which persisted throughout several months, and severe encephalitic symptoms, which persisted for 75 days. After 13 months, recovery was nearly complete. The patient's serum and cerebrospinal fluid contained rabies-neutralizing antibodies reaching maximum titers of 1:640 000 and 1:160 000, respectively. Titers of this magnitude have never been previusly recorded after suckling mouse brain vaccine treatment. This phenomenon, together with the epidemiologic, clinical, and laboratory data presented, supports the conclusion of a nonfatal case of rabies in man.
Subject(s)
Rabies Vaccines/therapeutic use , Rabies , Adrenocorticotropic Hormone/therapeutic use , Antibodies, Viral/analysis , Antibodies, Viral/cerebrospinal fluid , Betamethasone/therapeutic use , Biperiden/therapeutic use , Diazepam/therapeutic use , Diphenhydramine/therapeutic use , Female , Follow-Up Studies , Humans , Immunization, Secondary , Infusions, Parenteral , Middle Aged , Phenytoin/therapeutic use , Rabies/therapy , Remission, Spontaneous , Thiamine/therapeutic use , Vitamin B 12/therapeutic useABSTRACT
In Latin America, suckling mouse brain (SMB) vaccine has become the most commonly used vaccine for immunization of both man and animals against rabies. This vaccine is highly immunogenic, is relatively economical and easy to produce, and is believed to be free of the immunoencephalitogenic factor. From 1964 to the end of 1969, there were 40 reported cases of neurological disease following administration of SMB vaccine, 32 of which met the criteria for inclusion in this report. These 32 cases occurred in 8 different countries. In contrast to neurological disease following the administration of other types of nervous tissue vaccine, the majority of the cases following vaccination with SMB vaccine had a Guillain-Barré-type syndrome with peripheral nervous system involvement and a higher case-fatality rate. The causative agent has not been demonstrated. Modifications in the production and handling of the vaccine may be producing changes that are responsible.
