Home >News > ProMED翻訳情報(375回) ~フランスで発生した医療従事者の狂犬病曝露事例~

ProMED翻訳情報(375回) ~フランスで発生した医療従事者の狂犬病曝露事例~





Date: Sat 25 Apr 2015   Source: Nature World News [edited]



158 healthcare workers exposed to rabies in France — 1st case [2014] in over a decade




[In March 2014] French physicians identified a case of the deadliest disease in the world, rabies, in one unfortunate patient. Before it was even realized what he had, 158 healthcare workers had been exposed to the deadly virus. Now, experts are calling this a strong reminder that rabies is very real, even in countries that take the proper precautions.



Nature World News recently took an in-depth look at how rabies still affects the world.



“Rabies is close to 100 per cent fatal, but it is also almost 100 per cent preventable,” Kevin Doran, a spokesperson for the Global Alliance for Rabies Control, had said in a statement concerning that report.

『狂犬病はほぼ100%致死的だ、しかしまたほぼ100%予防が可能だ』狂犬病制御のための世界同盟(GARC)のスポークスマンであるKevin Doran氏はその報告書で述べている。


That’s because, while the means in which the rabies virus attacks a body (climbing a mammal’s nervous system like a ladder) makes it exceptionally hard to treat, stopping its progress before it reaches the brain — via proactive inoculation — is exceptionally effective. Unfortunately, not every person has access to this life-saving solution, and even in developed worlds a victim may not even realize they were bit by a potentially rabid animal. This is reportedly what happened in France’s latest case.



After returning from a 6-month stay in Mali, West Africa, a 57 year old French citizen found himself in an intensive care ward with a mild fever, abundant sweating, general pain, and a slowed heartbeat (about 40 beats per minute). The patient tested negative for Herpes simplex-1 and -2, HIV, syphilis, and epilepsy, among other conditions, and brain scans didn’t reveal anything out of the ordinary.



Unfortunately, this was just the beginning. A report and study of this case recently published in the Journal of Clinical Microbiology, detailed how “2 days after ICU admission, [the patient] developed bouts of hyperactivity, disorientation, and delirium with thoughts of impending death.” This alternated with periods of drowsiness and even brief returns to normalcy, where the man “seemed aware of his disorder and criticized it.”

不幸なことにこれは始まりに過ぎなかった。最近発行されたJournal of Clinical Microbiologyのこの例の報告および研究では『ICUに入院2日後(その患者は)迫りくる死の思いから活動亢進、妄想や幻覚などの見当識障害、精神錯乱状態に陥った』と詳細が記されていた。うとうと状態と短時間の平常状態を交互に起こしており、平常状態のときの患者は『自分の障害に気付いているように見え、それに不平を言っていた』。


Christian Brun-Buisson, head of the medical intensive care unit, and director of the Infection Control Unit at Assistance Publique Hopitaux de Paris, France, said in a statement that what was most disturbing was that there was “no obvious exposure to an animal bite, which made us search for an array of diseases before one of our team members suggested it could be a case of imported rabies.” A skin biopsy and saliva swabs finally confirmed the rabies diagnoses 13 days after the patient 1st was admitted. The patient tragically died 6 days later.



However, this meant that professionals were dealing with this man for 13 days before learning of his incredibly deadly infection – an oversight that resulted in 158 healthcare workers potentially exposed. “Hypersalivation was remarkable and the patient occasionally spat on ICU personnel,” the report reads.




A hasty investigation deemed 52 staff members at immediate risk and had them promptly vaccinated. Two professionals who worked directly with fluid samples also received immunoglobin treatment as an added precaution.



“This case serves as a reminder to physicians that rabies should be considered in patients presenting with unusual neurological symptoms and coming from a geographical area where rabies is a common disease,” said Brun-Buisson. “Making this diagnosis early is important, since there is a potential risk for caregivers to be contaminated if strict isolation precautions are not taken. This is obviously of utmost importance as rabies is a uniformly fatal disease.”[byline: Brian Stallard]



[This case occurred some 12 months ago but it is being posted to remind those unaccustomed to human clinical rabies what they should expect to see. Clinical memories are unfortunately short if not reinforced by new patients. And as this case exemplifies delays are expensive — 54 people had to be vaccinated in case they had been exposed while treating and managing this fatal case. – Mod.MHJ