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Rabies: California Girl Becomes Its Third U.S. Survivor
SAN FRANCISCO, California - Three weeks ago, 8-year-old Precious Reynolds had rabies. She was comatose in the University of California-Davis Children's Hospital, her body fighting off a vicious infection that almost no one survives.
Her grandmother sat beside her bed daily. Shirlee Roby recalls telling her granddaughter, an avid wrestler in California's Humboldt County town of Willow Creek, that she had "a big bad bug inside her. ... I told her she had to put him on the mat and put him in a half-nelson and pin him. And by golly if she didn't do it."
Today, Precious is one of only three people in the United States, and the first in California, known to have survived rabies. Until very recently, a rabies diagnosis was considered a death sentence.
The virus attacks the nervous system, damaging and disabling basic bodily functions from breathing to swallowing, eventually targeting the brain. Humans get the virus when they're bitten or scratched by infected animals.
Roughly 50,000 people die from rabies worldwide every year, but there are only three or four cases a year of full-fledged rabies in the United States. Stringent animal vaccination regulations have wiped out the disease in dogs and most cats, and a vaccine given shortly after a bite is highly effective at preventing illness.
Occasionally a person gets bitten and doesn't know it, or doesn't get the vaccine. Most U.S. cases of rabies in humans come from small bat bites. No one knows how Precious was exposed to rabies; the most likely culprit is a feral cat.
Rabies can incubate for several years, but Precious became sick a few weeks after playing with the cat. At first she had flu-like symptoms, and then she grew weak. By May 1, she was on a ventilator at the children's hospital, where she was diagnosed with encephalitis -- inflammation of the brain, usually caused by a viral infection.
UC Davis doctors called the head of California's encephalitis project, who insisted they test for rabies immediately.
"The next afternoon, she called me and said, 'You'd better sit down,' " said Dr. Jean Wiedeman, an associate professor of infectious diseases the children's hospital who headed Precious' team of doctors.
Rabies is such a rare diagnosis that only one doctor there had any experience with the disease. Dr. Jennifer Plant, assistant clinical professor of pediatrics at UC Davis Children's Hospital, had been one of the first doctors to see a boy treated at Children's Hospital Oakland in 2006. He died of rabies after almost a month of intense treatment.
"I think by default, I was the rabies 'expert,' having seen it once before," Plant said.
Two other people have survived documented rabies in the United States -- a Wisconsin teenager in 2004, and a Texas girl in 2009. The Wisconsin girl's treatment, now known as the Milwaukee protocol, was widely studied. Doctors wondered if rabies finally was curable.
The treatment, started on Precious the night she was diagnosed, involves putting patients into a drugged coma and doing everything possible to keep their body functioning while it fights off the infection. No specific medication fights rabies -- the body will kill it off eventually, if it can survive long enough.
"Essentially, we're putting her brain to sleep to protect it during this time," Plant said.
Precious was in a medically induced coma for a little more than a week. Then, slowly, Precious started waking up. She left the intensive care unit about three weeks after arriving at the hospital.
It's possible she's suffered some permanent neurological damage, but she's already up, using a walker and able to talk and write. She receives intensive rehabilitation and may be discharged as early as June 22, her grandmother says.
Doctors warn that Precious is not proof of a definitive rabies cure. Her immune system may be particularly adept at fighting off rabies, or the virus may be less virulent than the type that so often kills people.
Because rabies is often confused with other forms of encephalitis, there may have been other rabies survivors who never were identified, said Dr. Arup Roy-Burman, a pediatric intensive care physician at Children's Hospital Oakland who treated the 2006 case there and consulted with UC-Davis doctors.
Precious doesn't know how special her case is, her grandmother said. She just wants to go home, where she lives with her grandparents, two sisters, a brother and a cousin.
Her voice still scratchy from illness, Precious said she's most excited to see Copper, the family dog.
"I like animals," she said. "They're nice. Some of them."
Credits: By Erin Allday - NBCActionNews.com
