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ProMED翻訳情報(270回) ~米国で死亡したグアテマラからの移民に関する続報~


Date: 8 Jun 2014  Source: Houston Chronicle [edited]

The death of a Guatemalan immigrant from rabies last year [2013] [Rabies – USA (11): (TX) ex Guatemala, human 20130616.1775355] at a Corpus Christi hospital set off an international search for others who may have been exposed. More than 700 people were assessed for rabies exposure in what Ryan Wallace, a rabies expert for the U.S. Centers for Disease Control and Prevention, called a “very rare scenario,” the Corpus Christi Caller-Times reported ().
昨年(2013年)、1人のグアテマラ移民がCorpus Christi病院で狂犬病により亡くなった[記事 Rabies – USA (11): (TX) ex Guatemala, human 20130616.1775355 参照]ことにより、他に誰が(狂犬病ウイルスに)暴露されたのかを探す国際的な取り組みが始まった。Corpus Christi Caller-Times の報道によると、700名以上が調べられたが、アメリカCDC(Centers for Disease Control and Prevention)の専門家であるRyan Wallaceは、“(感染は)ほぼ考えられない”とコメントしたとのこと。

HM-H, 28, began showing symptoms only several days after Border Patrol captured him [near Hidalgo] in South Texas following his illegal entry [on 9 May] 2013. At an immigrant detention center, M-H repeatedly visited its medical clinic with symptoms including excessive saliva, anxiety, insomnia, trouble swallowing, and a rapid heart rate, according to CDC reports. Nine days after his initial capture, M-H was taken to Christus Spohn Hospital Kleberg [Kingsville, on 18 May 2013].
Doctors discovered air between his chest and lungs. His condition worsened after he was taken to Christus Spohn Hospital Memorial in Corpus Christi, and he eventually needed a ventilator to breathe. His temperature hit 104 F [40 C].
28歳のHM-H(死亡者のイニシャル?)は、2013年5月9日に不法入国した後、テキサス南部のHidalgo近辺で国境警備隊に捕まり、それから数日後に発症した。CDCのレポートによると、移民拘留センターにおいて、過剰流涎、不安、不眠、嚥下障害、心拍数上昇といった症状を見せて、M-Hは医務室に頻繁に通った。拘留から9日後の5月18日、M-HはKingsville のChristus Spohn Hospital Klebergに運び込まれた。医師は彼の肺と胸の間に空気泡を発見した(気胸?)。Corpus ChristiのChristus Spohn Hospital Memorialに移送された後に症状は悪化し、最終的には呼吸のためにベンチレーターが必要となった。体温は華氏104F(40℃)にまで上った。

“On the surgery ICU side, they couldn’t figure out what was wrong with him,” said Dr. Andy Russell, an emergency medicine resident at Memorial. “He didn’t seem to have any surgical issue. … He was very unstable, teetering on multi-organ failure, but we couldn’t figure out why.”
“外科の集中治療室では、彼の何が悪いのか分からなかった。”と、病院の救急治療専門の医師である Andy Russellは語った。“彼にはいかなる外科的な問題点も見当たらなかった・・・彼は不安定で、不定期に多臓器不全を起こした。しかし、我々にはその原因が分からなかった。”

His symptoms seemed to be textbook rabies, but there are only one to 6 rabies deaths in the U.S. each year. “The more we thought about it, the more we thought maybe he does have rabies,” Russell said. Tests came back positive.

There’s never been a laboratory-confirmed case of human-to-human rabies transfer, except for organ transplants. But M-H had traveled through 4 federal detention centers and 2 hospitals before being taken off life support on 11 Jun 2013. Health investigators identified 742 people who had been exposed to M-H. Ultimately, rabies vaccines were recommended for 23, among them, 3 agents who scuffled with him during his arrest, other detainees, and 5 health care workers.

The CDC was unable to determine how M-H had contracted the incurable virus. His virus was a close match to one in dogs in Guatemala, but no bite marks were found on his body, and his family did not recall him being bitten.

[Although classically the rabies incubation period is 21 days, there are countless cases where it has been a multiple of months since any known exposure. And in wildlife reservoir species, it has the capacity to aestivate and hibernate. Though this report does not confirm that he originally came from Guatemala, the previous report had authorities in Guatemala question his family, so it can be so presumed. Whether M-H would have survived if the Kleberg clinicians had read his symptoms correctly from the start is a matter for conjecture.