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Laboratory investigation of human deaths from vampire bat rabies in Peru
C K Warner1, S R Zaki, W J Shieh
1Rabies Section, Viral and Rickettsial Zoonoses Branch, and Infectious Disease and Pathology Activity, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention,
Abstract:
In the spring of 1996, multiple cases of an acute febrile illness resulting in several deaths in remote locations in Peru were reported to the Centers for Disease Control and Prevention (CDC). The clinical syndromes for these cases included dysphagia and encephalitis. Because bat bites were a common occurrence in the affected areas, the initial clinical diagnosis was rabies. However, rabies was discounted primarily because of reported patient recovery. Samples of brain tissue from two of the fatal cases were received at CDC for laboratory confirmation of the rabies diagnosis. An extensive array of tests on the formalin-fixed tissues confirmed the presence of both rabies viral antigen and nucleic acid. The virus was shown to be most closely related to a vampire bat rabies isolate. These results indicate the importance of maintaining rabies in the differential diagnosis of acute febrile encephalitis, particularly in areas where exposure to vampire bats may occur.
Insights
Acute febrile encephalitis cases in Peru were initially suspected to be rabies. Laboratory tests confirmed rabies, most closely related to vampire bat strains, highlighting its importance in differential diagnosis.
Area of Science:
- Virology
- Epidemiology
- Neurology
Background:
- Multiple deaths from an acute febrile illness with dysphagia and encephalitis occurred in Peru.
- Initial clinical suspicion pointed towards rabies due to frequent bat bites in affected regions.
- Rabies was initially dismissed due to reports of patient recovery.
Purpose of the Study:
- To confirm the diagnosis of the mysterious febrile illness in Peru.
- To identify the causative agent of the encephalitis and dysphagia syndrome.
- To assess the potential role of rabies virus in these fatal cases.
Main Methods:
- Received brain tissue samples from two fatal cases at the Centers for Disease Control and Prevention (CDC).
- Conducted extensive laboratory tests on formalin-fixed tissues.
- Performed molecular and immunological assays to detect viral presence and characteristics.
Main Results:
- Confirmed the presence of both rabies viral antigen and nucleic acid in the brain tissues.
- The identified virus showed closest relation to a known vampire bat rabies isolate.
- The findings contradicted the initial dismissal of rabies as a diagnosis.
Conclusions:
- Rabies should be considered in the differential diagnosis of acute febrile encephalitis.
- This is particularly relevant in geographical areas with potential exposure to vampire bats.
- The study underscores the diagnostic challenges and epidemiological importance of rabies in remote regions.