Friday, October 12, 2007

Zoo Noses

A 25 year old female spelunker presents to your clinic. Since you are thirsty, you pull out a bottle of water, and as you do so, she gasps in panic and looks terrified.

Challenge: What's the diagnosis?

It'd be impressive if you could figure it out from just that, but you take a more thorough history. The patient says that she's really thirsty but can't look at water. She's been having trouble swallowing. She's salivating and febrile. She thinks she had the flu last week: muscle weakness, loss of appetite, sore throat, headache, low grade fever, and nausea. You request a psychiatric consult which suggests recent hypomanic episodes.

It's a pretty cool case, but she'll die if you can't figure this out. You admit her to your service.

Related Questions:
1. What's up with spelunking?


Alex said...

google medicine returns rabid bats in caves

Craig said...

Zoo Noses

Encephalitic rabies presents in this fashion. After an incubation period of 1-3 months, there is a nonspecific flu-like prodrome lasting a few days. This is followed by either encephalitic rabies (most common), paralytic rabies, or non-classic atypical rabies. Encephalitic rabies includes hyperactivity (accounting for the psychiatric diagnosis of hypomania), persistent fever, fluctuating consciousness, painful pharyngeal or inspiratory spasms, hypersalivation, and seizures. Pharyngeal spasms occur upon encountering a draft of air (aerophobia) or when offered water (hydrophobia).

Rabies is caused by a neurotropic RNA virus transmitted zoonotically. Here, the likely animal is a bat from a cave from a recent spelunking adventure. Other major reservoirs in the U.S. include raccoons, skunks, and foxes (dogs account for the majority of cases in other countries). Treatment is essential and includes the rabies vaccine, intramuscular human rabies immunoglobulin, ribavirin, IFN-alpha, and ketamine.

Source: UpToDate.