Department of Internal Medicine (Neurology) and of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Neurol Sci. 2011 Sep;38(5):689-95. doi: 10.1017/s0317167100054056.
Worldwide, human rabies is prevalent where there is endemic dog rabies, but the disease may present unexpectedly in critical care units when suggestive clinical features have passed. In North America transmission from bats is most common and there is often no history of a bat bite or even contact with bats. Laboratory diagnostic evaluation for rabies includes serology plus skin biopsy, cerebrospinal fluid, and saliva specimens for rabies virus antigen and/or RNA detection. Rare patients have survived rabies, and most received rabies vaccine prior to the onset of illness. Therapeutic coma (midazolam and phenobarbital), ketamine, and antiviral therapies (dubbed the "Milwaukee Protocol") were given to a rabies survivor, but this therapy was likely not directly responsible for the favorable outcome. There have been many subsequent failures of similar therapeutic approaches. There is no scientific rationale for the use of therapeutic coma in human rabies. New approaches to treating human rabies need to be developed.
在全球范围内，只要存在地方性犬狂犬病，人类狂犬病就很普遍，但在出现提示性临床特征后，该病可能会出人意料地出现在重症监护病房。在北美，最常见的传播源是蝙蝠，而且通常没有蝙蝠咬伤史，甚至没有接触过蝙蝠。狂犬病的实验室诊断评估包括血清学检查加皮肤活检、脑脊液和唾液标本的狂犬病病毒抗原和/或 RNA 检测。少数患者幸存狂犬病，大多数患者在发病前都接种了狂犬病疫苗。一名狂犬病幸存者接受了治疗性昏迷（咪达唑仑和苯巴比妥）、氯胺酮和抗病毒治疗（称为“密尔沃基方案”），但这种治疗方法可能不是导致有利结果的直接原因。此后，许多类似的治疗方法都失败了。在人类狂犬病中使用治疗性昏迷没有科学依据。需要开发治疗人类狂犬病的新方法。
