The latest edition of CDC’s Morbidity and Mortality Weekly Reports describes a case of rabies in a Michigan man from 2009. While human rabies in most developed countries is very rare, this is yet another reminder of the ever-present risk of rabies exposure in many regions, and the ongoing need to be proactive to avoid this almost invariably fatal – but almost completely preventable – disease.

In the 2009 Michigan case, the man woke one day with a bat on his arm. Bats are classic rabies vectors, and you have to assume that any bat has rabies until proven otherwise. If you can’t be sure that you weren’t bitten or scratched (something that may be easier said than done, because bats bites can be very tiny), then you have to consider yourself exposed if you’ve had contact with a bat and the bat wasn’t tested and rabies-negative.

Unfortunately, the Michigan man did not seek medical attention, and nine months later he started to develop signs of rabies. It started off with pain and progressive numbness in his left hand and arm, and pain in his neck and back. He developed weakness in his left hand and soon could not grip anything or raise it more than a few inches.

While he was being evaluated in hospital, he developed breathing difficulties and had to be placed on a ventilator. Various diseases were considered and numerous tests were run. After a little initial improvement, he began to deteriorate, with more profound neurological signs.

Five days after he was admitted to hospital, his wife was asked about possible animal bites, but she didn’t know of any. A couple of days later, a relative recounted being told about the bat encounter, but there was little that could be done at that point, and the man died three days later. Rabies was eventually diagnosed.

Because of the potential risk of exposure, 11 family members that may have had contact with the man’s saliva received post-exposure treatment.

Sadly, you can almost guarantee that rabies could have been prevented if he had reported the bite and received post-exposure treatment (even months later). Rabies education is critical so that people know the risks of exposure and know to get medical advice after any encounter with a wild animal.

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