A year ago, a 54-year-old man died of rabies in Zhejiang province after being bitten by a wild dog without vaccination.

Recently, the Emergency Department of the First Affiliated Hospital of Zhejiang University School of Medicine treated a 54-year-old Tiantai man who died of rabies one year after he was bitten by a wild dog and spent a week in the EICU (Emergency Intensive Care Unit). The lesson of blood and tears is heartbreaking.

“It’s been almost a year since I was bitten by a wild dog, how can a person just lose it?!” In early September, 55-year-old Auntie Liao (a pseudonym) bawled her eyes out in front of the emergency intensive care unit of the First Hospital of Zhejiang University, refusing to believe that her partner, Master Hao (a pseudonym), was dying of a rabies attack.

“We are doctors not gods, this result is so heartbreaking and regrettable!” Dr. Yuanqiang Lu, Director of the Department of Emergency Medicine, explained that rabies has a nearly 100% mortality rate once it strikes, and most patients who die of rabies fail to receive rabies vaccination because of various reasons, such as paralysis or cost pain. He repeatedly emphasized, “If you are bitten by some animals, you must be vaccinated against rabies as soon as possible. In severe cases, even immunoglobulins should be injected promptly, or else it will cost your life! Don’t take it lightly!”

54-year-old man in Zhejiang Province had a “madness “.

Late at night on August 23, Master Hao (a pseudonym), a native of Tiantai, Taizhou, was rushed to the First Hospital of Zhejiang University by 120 ambulance after suffering from persistent convulsions and extreme emotional mania. Master Hao, 54 years old, is a farmer in Tiantai, as early as a month ago, his body has begun to appear abnormal - for many days dryness, photophobia, and seems to be unable to control himself, hands will involuntarily twitch …… patchouli, cold shower, all kinds of We tried everything, but his symptoms didn’t ease up at all, but got worse and worse.

“We all thought that he just had a cold and fever and went to the hospital to hang water on it, but who would have thought that he would be so sick,” he said. The old man cried and recalled that on the night of August 19, the abnormal Master Hao even jumped into the village pond because of the heat, but he was rescued in time by his fellow villagers. After that, he He went “crazy” even more, yelling that the left half of his body was numb and unconscious, while rolling all over the floor at home shouting “there are tens of thousands of ants biting me”, and he was finally sent to the local hospital by his family.

After an MRI examination, doctors at the local hospital found no obvious abnormalities, but saw that he had a high fever of 39 ℃, had begun to lose consciousness, difficulty swallowing and a lot of saliva, and recommended that he be urgently referred to the First Hospital of Zhejiang University.

When he was brought to the emergency department of the First Hospital of Zhejiang University, Master Hao was unusually manic, his hands were fisted, he could not stop dancing, and vomit was ejected from his mouth from time to time.

“The patient’s muscles were hard and convulsing, and it took us a great deal of effort to get him under control and sedated.” Dr. Shang Andong, an attending physician in the emergency department, recalled that Master Hao was already suffering from pharyngeal muscle spasm and confusion. “From the patient’s clinical manifestations, we highly suspected that he was infected with rabies virus, but he didn’t show the typical symptoms of rabies attacks like fear of water or wind, so we couldn’t confirm the diagnosis at the moment.”

“Is it possible to be bitten by a dog for a year and still get sick? It can’t be!” The company’s CEO, Auntie Liao, recalled that Master Hao had been bitten by a wild dog a year ago, and that he did not receive a rabies vaccination because he was distressed about the money, but simply cleaned the wound on his left leg with soap and water.

**The first time I saw this, I thought it was a good idea to take a look at it.

It’s the rabies virus**.

Currently, no institution routinely conducts antibody and nucleic acid tests for rabies virus, and the etiological diagnosis of rabies is a major challenge. Dr. Yuanqiang Lu, Director of the Emergency Department, was able to find a way out: he led the doctors in the Emergency ICU to take cerebrospinal fluid from Master Hao’s spinal cord and used high-throughput gene sequencing technology to catch the “culprit” within 24 hours after receiving the specimen. –The cause of the disease was indeed the rabies virus! However, Master Hao was unable to return to the hospital because he was never vaccinated and delayed seeking treatment after the attack.

“The rabies virus invades from the spinal cord to the back of the brain and spreads unusually quickly, ‘massacring’ a large number of brain cells, with the brain stem being the first to be affected and the most infected area. The virus mainly invades the human body through the broken skin or mucous membranes of the bite or scratch of an infected animal, stays in the human muscle tissue for a short period of time, replicates in a small amount, and then travels upward along the nerve endings to enter the central nervous system. The mortality rate of the disease is 100%.

“The clinical manifestations of rabies include excitement, fear of wind, fear of water, fear of light, difficulty swallowing, salivation, mania, etc. By this time, the virus is widely distributed in the central nervous system and extra-nerve organs.

Prior to the onset of the disease, the incubation period for rabies varies from 5 days to several years (usually 2 to 3 months, rarely more than 1 year). The length of the incubation period is related to the virulence of the virus, the nerve distribution at the site of penetration, and other factors. The greater the number of viruses, the more virulent they are, the more nerve-rich the site of invasion, and the closer they are to the central nervous system, the shorter the incubation period and the faster the onset of disease.

** After being bitten by an animal suspected of having the rabies virus

What to do?

What should I do after being bitten by an animal suspected of having the rabies virus? ***

Director Yuanqiang Lu introduces-

Squeeze out the blood from the wound immediately and rinse it repeatedly with 20% soap and water (or other weak alkaline detergent) for at least 15 minutes under certain pressure with running water.

2、Coat the wound with 2% iodine, 75% alcohol or other mucous membrane disinfectant with virus inactivating effect.

3. Within 24 hours after being bitten, go to a vaccination station immediately to receive a human rabies vaccine.

4、If the wound is very deep, in addition to the rabies vaccine, additional injections of rabies immune serum or globulin should be given.

**Be alert!

These misconceptions about rabies should be corrected immediately**.

The Chinese Center for Disease Control and Prevention (CDC) released the Technical Guidelines for Rabies Prevention and Control (2016). In the 21st century, rabies remains an important public health threat, with approximately 60,000 deaths worldwide each year, making it the most deadly infectious disease of animal origin. Asia has the highest number of rabies cases in the world, with an estimated annual death toll of 30,000.

Even so, there are still many misconceptions about rabies as follows.

**Myth #1: Only dogs can carry rabies virus. **

Wrong! Although 99% of rabies cases worldwide are caused by dogs, the natural reservoirs of rabies include a variety of carnivores and pteropods, including cats, foxes, wolves, jackals, skunks, raccoons, skunks, raccoons, raccoons, ocelots, and bats, all of which are natural reservoirs of rabies and can be infected with the rabies virus. Poultry, fish, insects, oysters, turtles and snakes are not infected with or transmit rabies virus.

**Myth 2: You can only get rabies if you are bitten. **

Wrong! Rabies virus is found primarily in the saliva of animals and can enter the human body through wounds or broken skin mucous membranes, and can be transmitted by scratching, licking exposed wounds, or biting without bleeding!

**Myth 3: The rabies vaccine is only effective if given within 24 hours of the bite. **

Wrong! The popular notion that it is valid for 24, 48, or 72 hours is just plain wrong! If you are bitten or scratched, of course, the sooner you get the rabies vaccine, the better, but there is no time limit, and as long as you get the vaccine before the attack and as long as you follow the instructions, you will be effectively immunized.

The more you do it, the more you will have to pay attention to your own cats and dogs.

Be on high alert when there is a noticeable change in their temperament, such as apprehension or fear, and when they are somewhat paranoid! Some are extremely friendly, wagging their tails and begging for mercy, but will bite at the slightest irritation and aggressively attack newcomers; some are isolated and become insensitive to their masters; and some develop strange eating habits, such as eating dirt, grass and wood. In the earliest stages of the disease, the saliva of infected animals contains a large amount of rabies virus, and they can be easily infected if they get close to, play with, or are bitten and scratched.

In the early stages of the disease, the infected animal enters an excitable phase, which is characterized by restlessness, running around, unpredictable biting and barking, and a frenzied state of aggression due to an inability to recognize acquaintances and people. Subsequently, the animal droops its tail, drools with its mouth open, has difficulty swallowing, and shakes its head. At an advanced stage, it soon developed respiratory distress and died of systemic collapse.

The lethality rate of the dreaded SARS is 10%; the lethality rate of heavy smallpox is 25%; the lethality rate of the Ebola virus is 50-90%; and the lethality rate of the rabies virus is 100%; at present, rabies cases in China are “three and a half”: more rural farmers, more men, more children under the age of 15 and more people over the age of 50. No matter who it is, the rabies virus should not be taken lightly!

(Originally titled: “A year ago was bitten by wild dogs without vaccination, Zhejiang 54-year-old man died of rabies, the old man collapsed! (Doctor’s Lament: We Are Not Gods)

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