Wilde Henry, Hemachudha Thiravat, Jackson Alan C
Faculty of Medicine, Division of Research and Department of Medicine, Chulalongkorn University Hospital, Bangkok 10330, Thailand.
Trans R Soc Trop Med Hyg. 2008 Oct;102(10):979-82. doi: 10.1016/j.trstmh.2008.04.008. Epub 2008 May 16.
Rabies remains a serious public health problem in many developing countries. A case in the West received media attention with the recovery of an American teenager who had not received rabies post-exposure prophylaxis. This case confirmed that rabies is not an invariably fatal disease. Review of the literature revealed only two survivors with good neurological status in nearly 40 years. Both had neutralizing antibodies in cerebrospinal fluid at or shortly after presentation, but the usual diagnostic tests for rabies were negative, a rather unique finding. It is highly probable that these two children managed to mount an unusually effective early immune response to the infection that contributed to, or was responsible for, recovery. Curative efforts for human rabies using critical care resources should especially target patients who show early neutralizing antibody. More basic research is needed to develop effective therapies for human rabies.
在许多发展中国家，狂犬病仍然是一个严重的公共卫生问题。西方的一个病例引起了媒体的关注，一名未接受狂犬病暴露后预防的美国青少年康复了。该病例证实狂犬病并非总是致命的疾病。文献回顾显示，近40年来仅有两名神经状态良好的幸存者。两人在就诊时或就诊后不久脑脊液中均有中和抗体，但常规的狂犬病诊断检测呈阴性，这是一个相当独特的发现。很有可能这两名儿童对感染产生了异常有效的早期免疫反应，这有助于康复或对康复起了作用。利用重症监护资源对人类狂犬病进行治疗时，应特别针对那些早期出现中和抗体的患者。需要开展更多基础研究以开发针对人类狂犬病的有效疗法。
