Tuesday, 27 September 2011

A three year old with rabies :(

A three year old with rabies :(
22.9.11 :

Very very sad case on the paediatric ward today; a 3 year old girl who had been bitten on the neck by a dog which was suspected to be rabid, six days ago. The dog had being acting excessively aggressive and frothy at the mouth so is quite likely to have had rabies. It had since been killed but not tested to see if it did indeed have rabies.

The girl had only just presented to hospital which is unfortunately too late even if the hospital did have the rabies treatment (which they do not yet, though they are trying to get hold of some to give to the girls family who will be potentially exposed whilst looking after the girl). Rabies is 100% fatal without treatment :(. To have a high chance of success the treatment should be given within 24 hours if the patient has not had prior vaccination against rabies; sometimes treatment is attempted later but if the individual has already developed rabies symptoms then it is too late.

The girl when we saw her was extremely twitchy and agitated in appearance, had obvious hypersalivation, her temperature was 39 degrees and she had vomited multiple times. Hope like hell these symptoms are a coincidence and she has a different treatable condition and the dog was not rabid at all.... But unfortunately this is rather unlikely and it takes very little medical knowledge to realise her symptoms combined with the bite, point to a high chance of rabies. She will probably die within a few weeks (most likely 4-5 days) and she’s only 3. It sucks big time and that is putting it extremely mildly.

In England someone with rabies would be isolated and barrier nursed and all staff would receive rabies vaccination just in case. Obviously that is not possible here, so I hope because she is only little she will be restrained ok if she develops the aggressive features of rabies otherwise the disease might be spread to someone else.

Rest of ward round pretty standard. Several other patients who had confusing symptoms given the differential cause of ?psychological today based again seemingly on simply the doctor's confusion as to the actual cause rather than any psychological features. It’s so unbelievably irritating and frustrating and I wish I knew more medicine so that I could diagnose these patients but realistically without some of the basic investigations they lack here then it is very difficult to do so. Basically if you do not have a classical presentation of one of about 4 diseases here then you are screwed. Today’s been hard and 6 weeks at this hospital feels like long enough the way I feel right now.

Halfadoc x

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