ABSTRACT
Rabies is an almost uniformly fatal encephalomyelitis with no treatment option other than supportive care for those who contract the illness. Mortality worldwide is estimated to be 40,000-70,000 people annually. Fortunately, public health measures begun in the 1940s and 1950s regarding vaccination and control of domestic animals in this country and the availability of safe and effective rabies postexposure prophylaxis treatment (RPEP) for humans has made rabies a rare disease in the United States. Community healthcare providers continue to play a pivotal role in the prevention of this devastating disease. This article emphasizes the challenges that the evolving epidemiology of rabies presents to our healthcare system, especially regarding international travel, the importance of domestic animal vaccination against rabies, the use and cost of RPEP, recent rabies epizootics in wildlife populations and the role of bats in disease transmission.
Subject(s)
Rabies/prevention & control , Animals , Chiroptera , Humans , Rabies/epidemiology , Rabies Vaccines , Travel , Wisconsin/epidemiologyABSTRACT
PURPOSE: Pyomyositis is a rare disease in temperate climate regions and frequently has a subacute presentation. Because of this, the entity is often misdiagnosed. PATIENTS AND METHODS: Two boys with acute lymphocytic leukemia (ALL) who presented with muscle pain, shortly after receiving induction chemotherapy, were evaluated. RESULTS: Presenting physical examination and laboratory findings were unremarkable except for extremity pain and tenderness. These symptoms were initially attributed to a neurotoxic side effect of vincristine. As the children's symptoms progressed, muscle abscess formation was finally delineated by gallium and computed tomography scans, and the diagnosis of pyomyositis was made. In both cases, the invading organism was Staphylococcus aureus. Both children responded well to incision and drainage of the abscesses and antibiotic therapy. CONCLUSION: Four cases of pyomyositis occurring in ALL patients shortly after induction chemotherapy have now been described. We feel that when children from this population present with muscle pain, pyomyositis should be part of the differential diagnosis. With early medical and surgical intervention, morbidity and mortality can be avoided.