Reims: a woman dies of rabies - In the news

2023-10-13 13:28:21

October 13, 2023

The patient was admitted to Reims University Hospital on October 7; she died of rabies two days later. This woman was scratched by a wild cat while traveling abroad.

She died despite rapid treatment. Thursday October 12, the Reims University Hospital (Marne) announced the death of a patient suffering from rabies, admitted on October 7 and died 2 days later. Accompanied by a man, she had presented herself at the hospital the previous Saturday. Both had been injured by a cat a few weeks earlier in a Maghreb country. Immediately, the healthcare staff identified the symptoms of rabies and treated him appropriately, hospitalizing him in intensive care. She unfortunately succumbed to the illness two days later. The man, who was asymptomatic, was administered a post-exposure prophylactic vaccination and placed under surveillance.

The National Rabies Reference Center (CNRR), under the control of the Pasteur Institute, is the only one authorized to make the diagnosis of rabies, confirmed the diagnosis on Wednesday October 11.

Very rare case of rabies in France

This case of rabies, a zoonosis caused by viruses of the Lyssavirus genus, on French territory is a so-called “imported” case. The last human cases acquired abroad date back to 2017 and the death of a 10-year-old child infected in Sri Lanka and to 2016 and the death of a man infected in Bangladesh. The last case acquired in mainland France was observed in 2019. The patient, who died, had been contaminated by the lyssavirus EBLV-1, a bat lyssavirus. Before that, no cases had been observed since 1924. And in animals, “France has been free from rabies in non-flying terrestrial mammals since 2001”, underlines the Pasteur Institute. The flying mammals being bats.

In France, three situations are considered at risk:

Bites, scratches and other contact with saliva on wounds or mucous membranes in a country where rabies circulates in dogs or wildlife (Guyana included);
contacts with bats, all over the world, particularly in mainland France;
bites, scratches and contact with wounds or mucous membranes with an animal that has traveled illegally outside the European Union in anti-rabies vaccination.

A post-exposure prophylactic vaccine

In the event of contact with a suspicious animal, treatment consists of immediate cleaning of the wounds with soap and water for 15 minutes and the application of an antiseptic. Prophylaxis includes a vaccine and anti-rabies immunoglobin, antibodies, for the most severe exposures.

« In 2022 in France, 2,391 people received post-exposure prophylaxis in a French anti-rabies center, including 62.2% of people exposed abroad. details the Pasteur Institute. Done on time, prevention is 100% effective. “Treatment must be carried out quickly after exposure, before the appearance of the first symptoms which signify an inexorably fatal course”, adds the Pasteur Institute.

After an incubation which can last 2 to 3 months, the first symptoms are a fever accompanied by pain and tingling or burning at the site of the injury.

There are two forms of rabies, as detailed by the WHO:

“The ‘furious’ form, with hyperactivity of the patient, excitability, hallucinations, lack of coordination, hydrophobia (fear of water) and aerophobia (fear of drafts or fresh air) . Death occurs within a few days due to cardiorespiratory arrest.
The paralytic form concerns approximately 20% of human cases. The evolution is then less spectacular and generally longer than for furious rabies. The muscles gradually become paralyzed, starting from the site of the injury. The coma sets in slowly and the patient eventually dies. Paralytic rabies cases are often misdiagnosed, contributing to underreporting of the disease. »

The virus affects the central nervous system and “leads to progressive and fatal inflammation of the brain and spinal cord.”

Worldwide, rabies is responsible for 59,000 deaths each year, mainly in Asia and Africa and most often after the bite of a rabid dog.

Source : WHO, rabies, September 20, 2023 – Institut Pasteur, rabies, October 2023 – Reims University Hospital, October 12, 2023
Written by : Dorothée Duchemin – Edited by Vincent Roche