Monday, January 15, 2018

Human rabies

A 6-year-old Orlando boy who was scratched or bitten by a bat and contracted rabies has died. Ryker Roque died at an Orlando hospital on Sunday, according to a post from the online fundraising website GoFundMe.

"We fought, Ryker fought very hard, he is our soldier," the post said. "We lost our fight today, January 14, 2018. We have to lay or angel to rest now."

Ryker's father, Henry Roque, lost his job during the ordeal and now the family seeks donations and prayers, the post said.

The boy was bitten by a bat and became infected with the rabies virus, the post said. Two weeks later, the boy began experiencing spasms and couldn't walk, so they rushed him to the hospital.

Multiple media outlets reported that Ryker's father found a bat and placed it into a bucket. Henry Roque told the boy not to touch it, he said, but Ryker reached in and touched the animal anyway. Henry said the bat scratched his son.

He told NBC News that he frantically Google searched what to do, so he washed his son's hands with soap and hot water for several minutes. The boy was scared of getting a rabies shot though, so he didn't receive treatment soon enough.

Later, Ryker started experiencing finger numbness and a headache.

According to, Henry Roque said: "They went frantically looking for the other doctors to tell them that it was a bat and how severe it was. And then they all came in. We had a conference and they explained to me that it's almost always lethal."

He was put into a medically induced coma and underwent a treatment known as the "Milwaukee Protocol" in hopes of saving his life. The treatment has saved the lives of two other children in America.

According to the Mayo Clinic, rabies is a deadly virus that spreads to people from the saliva of infected animals and is usually transmitted through a bite. Bats are among the animals most likely to transmit rabies in America. Once symptoms of rabies begin to show, the disease is nearly always fatal, the organization said.

Symptoms include: fever, headache, nausea, vomiting, agitation, anxiety, confusion, hyperactivity, excessive salivation, hallucinations, insomnia and partial paralysis.

Rabies kills more than 59,000 people every year, mostly children in Africa and Asia, according to the Centers for Disease Control and Prevention.

He said he washed the wound thoroughly but didn't take the boy to the hospital because he cried when he was told he would get shots.

McDermid RC, Saxinger L, Lee B, Johnstone J, Gibney RT, Johnson M, Bagshaw SM. Human rabies encephalitis following bat exposure: failure of therapeutic coma. CMAJ. 2008 Feb 26;178(5):557-61.

We started the Milwaukee Protocol 15 days after symptom onset (3 days after diagnosis). The Protocol consisted of inducing a therapeutic coma (infusions of ketamine, midazolam and propofol titrated to burst-suppression pattern on the electroencephalogram) and antiviral therapy (ribavirin, amantadine). We also provided metabolic supplementation (with tetrahydrobiopterin and L-arginine). We monitored regional cerebral perfusion using transcranial Doppler ultrasonography. Serial serum, saliva and cerebrospinal fluid samples were assessed weekly for immune response and viral clearance.

Jackson AC. Current and future approaches to the therapy of human rabies. Antiviral Res. 2013 Jul;99(1):61-7.


Human rabies has traditionally been considered a uniformly fatal disease. However, recent decades have seen several instances in which individuals have developed clinical signs of rabies, but survived, usually with permanent neurologic sequelae. Most of these patients had received prophylactic rabies vaccine before the onset of illness. The best outcomes have been seen in patients infected with bat viruses, which appear to be less virulent for humans than strains associated with other rabies vectors. In 2003, an article by rabies experts suggested that survival might be improved through a combination of vaccine, anti-rabies immunoglobulin, antiviral drugs and the anesthetic ketamine, which had shown benefit in an animal model. One year later, a girl in Milwaukee who developed rabies after bat exposure was treated with some of these measures, plus a drug-induced (therapeutic) coma, and survived her illness with mild neurologic sequelae. Although the positive outcome in this case has been attributed to the treatment regimen, it more likely reflects the patient's own brisk immune response, as anti-rabies virus antibodies were detected at the time of hospital admission, even though she had not been vaccinated. This conclusion is supported by the failure of the "Milwaukee Protocol" to prevent death in numerous subsequent cases. Use of this protocol should therefore be discontinued. Future research should focus on the use of animal models to improve understanding of the pathogenesis of rabies and for the development of new therapeutic approaches.

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