A previously healthy 20-year-old man is brought to the emergency department for fever, dysphagia, drooling, and poor coordination. The symptoms started last week with mild fever, throat pain, and malaise. He was able to eat some food but is afraid to drink any fluids as he feels his "throat closing up." The patient, an anthropology student, went on a school trip 2 months ago during which he explored several caves. He took several over-the-counter analgesic medications without relief. He does not recall any bites, scratches, or animal exposures. The patient has received all standard immunizations and takes no medications. He is febrile and tachycardic. Examination shows dehydration, lethargy, and ataxia. Drool is pooling in his mouth. No pharyngeal erythema or exudates are seen. The patient's family is concerned about his prognosis. Which of the following is the most accurate response?

Question

A previously healthy 20-year-old man is brought to the emergency department for fever, dysphagia, drooling, and poor coordination.  The symptoms started last week with mild fever, throat pain, and malaise.  He was able to eat some food but is afraid to drink any fluids as he feels his "throat closing up."  The patient, an anthropology student, went on a school trip 2 months ago during which he explored several caves.  He took several over-the-counter analgesic medications without relief.  He does not recall any bites, scratches, or animal exposures.  The patient has received all standard immunizations and takes no medications.  He is febrile and tachycardic.  Examination shows dehydration, lethargy, and ataxia.  Drool is pooling in his mouth.  No pharyngeal erythema or exudates are seen. The patient's family is concerned about his prognosis.  Which of the following is the most accurate response?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfbb_d05c_8f63_015200a1f0ba_MD0005_00 Human rabies is a life-threatening infection characterized by hydrophobia and neurologic decline. Post-exposure prophylaxis is effective only in preventing disease prior to manifestation of symptoms. After disease onset, treatment is primarily palliative, and most patients suffer from coma and death within weeks of illness onset. Family members should be advised to expect long-term neurologic deficits in the rare chance that the patient does survive (Choice A). (Choice B) Rabies is a viral infection; antibiotics have no role in its treatment. (Choice C) Post-exposure prophylaxis with rabies immune globulin and rabies vaccine can help prevent onset of the disease; it is not helpful after the onset of clinical manifestations. (Choice D) The Milwaukee protocol is an experimental approach to rabies treatment that consists of therapeutic coma induction and antiviral therapy. Although a few patients with suspected rabies have survived with this protocol, several have died despite this investigative therapy. Routine implementation of the protocol is currently not recommended. Educational objective: Rabies is an almost universally fatal disease once patients are symptomatic. Treatment is primarily palliative. References: Diagnosis, management and post-mortem findings of a human case of rabies imported into the United Kingdom from India: a case report. (http://www.ncbi.nlm.nih.gov/pubmed/24708671) Rabies surveillance in the United States during 2012. (http://www.ncbi.nlm.nih.gov/pubmed/24004227)

A Previously Healthy 20-Year-Old Man Is Brought to the Emergency