The Red-Light District

Exploring the carnal and taboo

Rabies from an Organ Transplant

Yes, it can happen.

Once upon a time I was grilling meat when a scrawny raccoon creeped up behind me and licked my ankle. The scratch of his wriggly, little tongue made me jump, and I dropped the plate of hot meat that I was holding. I ran into the house screaming, and my brother came out and chased the critter away. (But not before the raccoon had a couple minutes to feast upon ribeye and shish kabob.) In order to figure out whether I needed a rabies vaccination, my mom called my uncle who’s a pediatrician. He advised that if I weren’t bitten then there would be no need for the shots. He was right; I’m still alive.

To be sure, in more developed nations rabies is rarely fatal. For example, in the United States an average of two people die from rabies a year, and most cases are attributable to bat bites. Most people are aware that they’ve been bitten—after all, it’s hard to ignore a rabid dog chasing you down and biting you on the butt. But, occasionally, exposure is harder to discern. For example, if you awake to find a bat in your house, you should be vaccinated--the bat could have bitten you while you were sleeping.

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If you develop rabies, you are almost assuredly going to die. Although an experimental symptomatic treatment does exist, which is called the Milwaukee Protocol, only a handful of people have survived the disease.  Rabies often begins with fever and vomiting and in days to weeks escalates to full-blown encephalitis (brain swelling) and brain death.

In the July 24/31 issue of JAMA, I read about a particularly scary case of rabies that occurred in a kidney recipient. Interestingly, it took a very long 18 months for the disease to manifest and kill the recipient. Furthermore, only one of the 4 recipients who received donations from the infected donor developed rabies. Of note, two other clusters of rabies have been linked to organ donation, and in both these clusters, all recipients without a history of rabies vaccination were dead within 6 weeks.

In a seemingly karmic twist, several years later, my brother who chased away the raccoon that licked me (and thus disrupted his sumptuous meal of juicy meat) woke up to find a bat in his apartment. He had to go into the health department and receive rabies shots. Fortunately for him, rabies shots are no longer administered in the stomach, and he received them in his arm instead.

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Naveed Saleh, M.D., M.S., attained a medical degree from Wayne State University School of Medicine and a master's degree in science journalism from Texas A&M.

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