Treatment that saved a life to be tried again
May 10, 2006, 10:47PM
Treatment that saved a life to be tried again
By LEIGH HOPPER
Copyright 2006 Houston Chronicle
An experimental treatment doctors hope will save the life of an Humble teen
infected with rabies could become the standard of care - whether or not it works
this time.
Such is the desperation of physicians in the face of a truly horrifying disease.
Rabies paralyzes its victims, robs them of speech and causes convulsions and
coma before certain death.
With one exception.
A Milwaukee teen, Jeanna Giese, became the world's first known unvaccinated
rabies survivor in 2004, after being treated with a unique combination of
existing drugs described last year in the New England Journal of Medicine.
Today, her doctor, Dr. Rodney Willoughby, a pediatric infectious disease
specialist at Children's Hospital of Wisconsin, is meeting with officials at the
U.S. Centers for Disease Control and Prevention to standardize that regimen in
hopes his sole success story will be repeated.
Since that 2004 success, the CDC has paired Willoughby with doctors treating
other patients diagnosed with rabies on four occasions, including the critically
ill Humble student at Texas Children's Hospital.
"If it can be done again, if you have a 100 percent fatal disease and you do
something not once, but twice ... suddenly you've got yourself a cure,"
Willoughby said Wednesday. "If we can get one more, or two more (survivors),
then scientifically it's a slam-dunk and we can start figuring out which piece
is important."
In the New England Journal of Medicine, Willoughby and his colleagues described
how they treated Giese with sedating and antiviral drugs, such as ribavirin and
amantadine, after cautioning her parents "about the probable failure of
antiviral therapy and the unknown effect of the proposed therapy, as well as the
possibility of severe disability if the patient were to survive."
The Milwaukee doctors improvised the treatment approach after combing through
reports of other human rabies cases. One hypothesis was that death resulted from
a "neurotransmitter imbalance" in the brain. A search of neurotransmitters
involved in rabies identified a drug called ketamine with specific activity
against rabies in lab animals, so that drug was added to the mix.
Ribavirin, which Willoughby didn't consider useful for rabies, was recommended
by the CDC. Since ribavirin protects the heart - and some patients with rabies
die from cardiac arrest - he agreed to give it a try.
Giese was put into a medically induced coma to give the drugs and her immune
system a chance to fight the disease. On the eighth day of her hospitalization,
the teen's salivation - a hallmark of rabies - decreased. On the 10th day, she
developed a high fever. But by the 19th day, she was able to wiggle her toes,
gaze at her mother, and squeeze hands in response to commands.
Scientists still don't know precisely why Giese lived.
Willoughby said the protocol has not rescued other patients since then, but
"none of those attempts have been even close to ideal." In one case, a
transplant patient who developed rabies from infected tissue lived for 56 days.
In another, a boy from India developed rabies despite being vaccinated.
Last month, Willoughby tried to help physicians treating a patient in Bangkok,
but doctors could not obtain the necessary medications. The patient died.
Of the world's 55,000 human rabies infections each year, most occur in remote,
poor settings where medical care is out of reach.
Willoughby said Giese's parents, who could not be reached for comment Wednesday,
usually welcome the chance to talk about their daughter.
"But I wish they'd stop it," Willoughby said, "because she's got to go back to
being a regular teenager."
leigh.hopper@...
http://www.chron.com/disp/story.mpl/health/3855589.html