UK Man Dies of Rabies Following 2 Months without Symptoms After Cat Bite in Morocco

Doctors who treated Omar Zouhri from Aylesbury, England missed a diagnosis of rabies as the man was dying of rabies in early November 2018. The infection followed a cat bite that he suffered on a vacation in Morocco. Zouhri was vacationing in Morocco on August 30, 2018 when he was bitten by the rabid cat. He died on November 4, 2018 after he returned England and had no symptoms for two months. Omar Zouhri suddenly began to suffer pain, partial paralysis and paresthesia in his right hand.

Omar Zouhri, age 58, took himself to Stoke Mandeville Hospital in Aylesbury, England when began suffering pain and partial paralysis in his hand. Initial tests at the hospital failed to diagnose rabies, producing negative results. An autopsy confirmed the cause of death as rabies.

Usually symptoms appear 1 to 3 months, although they can appear as early as a few days after exposure to the virus. The illness is characterized by fever and pain or a tingling sensation at the wound site. As a result of inflammation to the brain and spinal cord, some patients present with anxiety, hyperactivity, convulsions, delirium, and have a fear of swallowing or drinking liquids, as well as a fear of moving air or drafts. In other patients, muscles become paralysed followed by a coma. Once symptoms are present, most patients die within 1 or 2 weeks.

— International Association for Medical Assistance to Travellers (IAMAT)

As his condition declined, Zouhri was transferred on November 1, 2018 to the specialist infectious diseases unit at the John Radcliffe Hospital in Oxford. Zouhri died within a few days. An inquest into his death is being investigated by the coroner. Another hearing is scheduled for March 2019.

At the first hearing, Senior Coroner Darren Salter testified that during the time of Zourhi’s death on November 4, experts at the infectious diseases department were unable to diagnose his condition, which had deteriorated quickly and severely. He died three days after his transfer to John Radcliffe Hospital.

Most rabies infections occur in Asia and Africa. Authorities recommend series of 3 pre-exposure rabies vaccination shots for persons planning extended stays or work assignments in remote and rural areas, especially in Africa, Asia, Central and South America. According to medical authorities, the pre-exposure series simplifies medical care if a person is bitten by a rabid animal. The pre-exposure series allows enough time to travel from a remote area to seek medical attention. Although the pre-series provides adequate initial protection, rabies virus-exposed patients are still required to be treated with two additional post-exposure doses.

According to International Association for Medical Assistance to Travellers (IAMAT), Travellers who have not received the pre-exposure series for rabies need 4 to 5 shots of the rabies vaccine (depending on a person’s health status). The Human Rabies Immune Globulin (HRIG) which is calculated as 20 IU (International Units) per kilogram of body weight. The full dose of HRIG should be injected into and around the bite site and if there is any HRIG remaining, it is given intramuscularly in another part of the body away from the wound. In some countries purified Equine Rabies Immune Globulin (ERIG) is used for post-exposure therapy when HRIG is not available. IAMAT reports that HRIG is in short supply worldwide and is often not available in rural and remote settings, including urban areas.

IAMAT warns travelers to be aware that medical providers in a remote area may offer daily rabies treatment injections over a period of 14 to 21 days. IAMAT warns that these treatment injections may be derived from one of the older animal brain-derived vaccines. IAMAT recommends that bite victim patients avoid the prolonged treatments due to serious side effects.

Rabies is almost always a fatal disease caused by a virus that attacks the central nervous system. The virus is present primarily in the saliva, brain tissue and spinal fluid of a rabid animal.

The rabies virus is transmitted to humans by mammals. Among wild animal species, rabies is more common in bats, skunks, raccoons and foxes, but the disease also has been found in deer and in large rodents, such as woodchucks. Cats, dogs and livestock can get rabies, too, if they are not vaccinated. Some animals, including chipmunks, gerbils, guinea pigs, hamsters, mice, rabbits, rats and squirrels, rarely get rabies.

Most of the recent cases of human rabies that have occurred in the United States have been caused by rabies virus from bats.

See also …

IDPH — Rabies








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