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Update in Infectious Diseases

John G. Bartlett, MD
[+] Article and Author Information

From Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: John G. Bartlett, MD, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21205-2191; e-mail, jb@jhmi.edu.


Ann Intern Med. 2006;144(1):49-56. doi:10.7326/0003-4819-144-1-200601030-00009
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This Update in Infectious Diseases reviews important literature from 2004 related to infectious diseases. The year had significant achievements, including substantial progress in the area of antiviral therapy for hepatitis B and C. The severe acute respiratory syndrome (SARS) was defeated; although we may not be able to fully attribute its disappearance to the public health efforts of the World Health Organization, the agency showed great leadership during a period of crisis. Intensive intervention also prevented a major public health crisis from materializing after the Asian tsunami. Within 48 hours, 60 major organizations established a presence in the area to provide antibiotics and to vaccinate disaster victims against measles. The year also introduced several new challenges; perhaps the greatest was the threat of avian influenza, which loomed large as yet another example of nature's mockery of man. The following papers represent the medical reports that guided research in the field in 2004.

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Curing Human Rabies
Posted on February 6, 2006
Richard Frumer
prefer not to list
Conflict of Interest: None Declared

Feb. 6, 2005

The Editor Annals of Internal Medicine 190 N. Independence Mall West Phila., PA 19106-1572

To the Editor:

The recent reporting of human recovery from rabies (1,2) may be a reminder of just how unfortunately lethal the disease is.

In addition to the Wisconsin case (2) literature may contain some clues as to what may be a successful treatment of clinical rabies. There is some interesting, although old, evidence that quinine may be curative of rabies. (3) Quinine's ability to treat cardiac arrhythmias, and its ability to treat symptoms of lupus may buttress the possibility that quinine can be useful in treating rabies in light of the disease's possible mechanisms of fatality. (4) If quinine can normalize rabies associated arrhythmias, as well as dampen a overly robust immune response to the rabies infection perhaps this can ameliorate rabies associated intracranial hypertension.

Furthermore, at least two of the more modern reported recoveries from rabies involved use of Dilantin (i.e. phenytoin). (4,5) Phenytoin's ability to treat seizures is well known; however, it also can have an anti -arrhythmic effect.

Old literature (as well as recent) may need to be viewed carefully. However, given what may be an almost 100 percent fatal outcome of rabies in humans, perhaps a fresh examination is warranted.

Sincerely,

RICHARD FRUMER

References

1. Bartlett JG. Update in Infectious Diseases. Ann Intern Med 2006; 144:49-56.

2. Willoughby RE Jr, Tieves KS, Hoffman GM, Ghanayem NS, Amlie-Lefond CM, Schwabe MJ, Chusid MJ, Rupprecht CE. Survival after Treatment of Rabies with Induction of Coma. N Engl J Med 2005; 352:2508-14.

3. Harris DL. A Clinical Report of Seven Cases of Hydrophobia Together With a Case Clincally Similar, With Recovery Following The Injection Of Quinin. JAMA 1913;61:1511-14.

4. Hattwick MA, Weis TT, Stechschulte CJ, Baer GM, Gregg MB. Recovery from Rabies A Case Report. Ann Intern Med 1972;76:931-42.

5. Porras C, Barboza JJ, Fuenzalida E, Adaros HL, Oviedo de Dias AM, Furst J. Recovery from Rabies in Man. Ann Intern Med 1976; 85:44-48.

Conflict of Interest:

None declared

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