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Case Report: Failure of Therapeutic Coma in Rabies Encephalitis

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  • 1 Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India;
  • | 2 Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India;
  • | 3 Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India;
  • | 4 Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India;
  • | 5 Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India;
  • | 6 Section of Neuropathology, Department of Neurological Sciences & Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India

Rabies encephalitis is a fulminant, almost universally fatal infection involving the central nervous system. A unique treatment protocol, including anti-exicitotoxic therapy and induced coma was credited with the survival of a vaccinated teenager with bat rabies encephalitis in 2005. However, multiple efforts to replicate this expensive and intense protocol have not been successful. In this article, we report the failure of the protocol in Indian patients with canine-acquired rabies and elucidate the potential explanations for the failure of the protocol in our patients.

Author Notes

Address correspondence to Abi Manesh, Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India. E-mail: abimanesh@gmail.com

Authors’ addresses: Abi Manesh, Rajiv Karthik, Ooriapadickal Cherian Abraham, and George M. Varghese, Department of Infectious Diseases, Christian Medical College and Hospital Vellore, Vellore, India, E-mails: abimanesh@gmail.com, rajivkarthik@gmail.com, ocherianabraham@gmail.com, and georgemvarghese@hotmail.com. Reeta Subramaniam Mani, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India, and Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, Bengaluru, India, E-mail: drreeta@gmail.com. Kishore Pichamuthu, Division of Critical Care, Christian Medical College and Hospital Vellore, Vellore, India, E-mail: drpichamuthu@yahoo.com. Manjeera Jagannati, Department of Medicine, Christian Medical College and Hospital Vellore, Vellore, India, E-mail: manjeeraj@hotmail.com. Vivek Mathew, Department of Neurological Sciences, Christian Medical College and Hospital Vellore, Vellore, India, E-mail: vmathew@cmcvellore.ac.in. Geeta Chacko, Section of Neuropathology, Department of Neurological Sciences & Pathology, Christian Medical College and Hospital Vellore, Vellore, India, E-mail: geetachacko@cmcvellore.ac.in.

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