MedQA_jp

狂犬病ウイルスの不稔感染 [頓挫性狂犬病] が推定されるヒト狂犬病の1症例
MMWR Weekly
Presumptive Abortive Human Rabies — Texas, 2009
February 26, 2010 / 59(07);185-190
　http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5907a1.htm?s_cid=mm5907a1_e

症例: 17歳女性。2009年2月25日、地域病院の救急外来受診(ED)。
コウモリへの暴露歴あり (暴露前・後の狂犬病ワクチン接種なし)

The patient recalled that approximately 2 months before her headaches began she had entered a cave while on a camping trip in Texas and came into contact with flying bats. Although several bats hit her body, she did not notice any bites or scratches. The patient also reported owning pet ferrets and a dog; all were in good health and under routine veterinary care. … The patient reportedly had never received rabies prophylaxis.

What is already known on this topic?
Only six human rabies survivors have been well documented after clinical onset, and none of the survivors had abortive rabies (i.e., recovery without intensive care).

狂犬病発症後に文書で十分に立証されたヒト狂犬病生存者はわずか 6人であり、生存者の誰も abortive rabies [不稔感染の狂犬病 頓挫性狂犬病] (すなわち, 集中治療を受けずに回復)ではなかった。

What is added by this report?
This is the first reported case in which certain clinical and serologic findings indicate abortive human rabies and in which, despite an extensive medical investigation, no alternate etiology for the illness was determined.

信頼できる臨床および血清所見がヒト狂犬病不稔感染を示し、詳しい医学研究にもかかわらず、他の病因の可能性が決定されなかった初めての報告例である。

What are the implications for public health practice?
Clinicians treating possible human rabies, indicated by acute, progressive infectious encephalitis, a compatible exposure history, and serologic evidence of a specific lyssavirus response, should contact their state health department for engagement with CDC; public education should continue to stress the importance of avoiding exposure to bats and seeking prompt medical attention after exposure to any potentially rabid animals.

急性で進行性の感染性脳炎、矛盾しない感染暴露歴、lyssavirusに対する特異的反応の血清学的エビデンスによって示されるヒト狂犬病の感染可能性のある患者治療を行う臨床医は、米国CDCとの取り決めにより州保健局に連絡すべきである; 一般への啓蒙・教育はコウモリへの暴露を避け、狂犬病の可能性のある動物に暴露した後に迅速な治療を求めることの重要性を強調しつづけるべきである。