Jeanna Giese

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According to the documented state of science, Jeanna Giese (* 1989 in Fond du Lac , Wisconsin ) is the first person who survived a rabies infection with a subsequent symptomatic outbreak of the disease without serious permanent consequential damage , without receiving the established treatment with antiserum for rabies to have. It is considered to be the sixth documented case of a patient who survived rabies after the onset of clinical symptoms. Her treatment consisted of medication to induce sedation ( analgosedation ) and the administration of antiviral drugs . However, it is not certain whether there is actually a connection between this experimental therapy and the positive outcome.

infection

Giese was bitten on her left index finger by a bat in September 2004 at the age of 15 after finding the injured animal. 37 days after the bite, she developed the typical symptoms of a rabies infection and was admitted to hospital with difficulty walking and tremor (muscle tremors). After her condition deteriorated, she was transferred to the Children's Hospital of Wisconsin in Wauwatosa . Here, the suspicion of a rabies infection was confirmed after laboratory tests by the Centers for Disease Control and Prevention .

treatment

If untreated, rabies is considered fatal. The only established effective treatment is the administration of a specific antiserum immediately after an infection is suspected, which usually occurs through the bite of an infected animal. However, this treatment is considered ineffective after the onset of clinical symptoms, as in the case of Giese. For this reason, her parents agreed to an experimental therapy suggested by the doctors at Children's Hospital of Wisconsin. As part of this treatment, the drugs ketamine and midazolam were used to induce analgesic sedation , which was intended to protect the nervous system from the consequences of the infection. In addition, the antiviral drugs ribavirin and amantadine were given in order to inhibit the infection until the body's own immune response against the rabies virus developed.

No virus could be detected 31 days after the start of treatment, so Giese was able to leave the hospital's isolation ward. After initial concerns about possible damage to the brain, it later became apparent that the patient's cognitive abilities had hardly been impaired by the infection and the treatment. Following the treatment, Jeanna Giese completed several weeks of rehabilitation training . On January 11, 2005, she was released from the hospital.

Aftermath and evaluation

It is unclear why she survived the infection and to what extent this was related to the experimental therapy. It is believed that most deaths from rabies are likely to be due to temporary severe brain dysfunction rather than irreversible brain damage. Therefore, it is possible that sedation was critical to survival. On the other hand, it cannot be ruled out that the virus strain with which it was infected by the bite was only weakly pathogenic . An exceptionally quick and strong reaction from their immune system may also have contributed to survival.

The documented side effects of treatment include hemolytic reactions , pancreatitis (inflammation of the pancreas ), acidosis, and hepatotoxic effects. Her condition has continued to improve since she was discharged from the hospital. Among other things, she is able to walk and ride a bike again without assistance. Occasional secondary symptoms of the infection include gait disorders, speech disorders known as dysarthria , and choreoathetosis , i.e. twitching and helical movements of the arms, legs and facial muscles .

Since the treatment of Jeanna Giese, further attempts to treat patients with symptomatic rabies with a similar therapy have failed in at least four cases. In May 2006, for example, doctors at the Texas Children's Hospital in Houston tried analogous treatment to save the life of a 16-year-old boy who had also been infected by a bat bite. However, despite treatment, he died about a week after the symptoms appeared. According to a spokeswoman for the clinic, the boy's disease was characterized by a faster and more severe course compared to Jeanna Giese.

By the beginning of 2013, five more patients had survived in 41 treatment attempts worldwide.

Individual evidence

  1. ^ William T., ea: Long-Term Follow-up after Treatment of Rabies by Induction of Coma . In: New England Journal of Medicine, 2007, 357: 945-946; here online
  2. ^ Willoughby RE, ea: Survival after Treatment of Rabies with Induction of Coma . In: The New England Journal of Medicine, 2005; 352: 2508-2514; here online

literature

  • RE Willoughby Jr., KS Tieves, GM Hoffman, NS Ghanayem, CM Amlie-Lefond, MJ Schwabe, MJ Chusid, CE Rupprecht: Survival after Treatment of Rabies with Induction of Coma. In: New England Journal of Medicine. 352 (24 )/2005. Massachusetts Medical Society / New England Surgical Society, pp. 2508-2514, ISSN  0028-4793

Web links

personal data
SURNAME Giese, Jeanna
BRIEF DESCRIPTION American survivors of a rabies infection with a subsequent symptomatic outbreak of the disease
DATE OF BIRTH 1989
PLACE OF BIRTH Fond du Lac , Wisconsin