Carpal tunnel was the first diagnosis doctors gave a 65-year-old Virginia woman complaining of arm pain — but she was actually dying of the rabies virus, according to public health officials.
Doctors prescribed the woman hydrocodone painkillers and anti-inflammatory drugs to treat carpal tunnel on May 6, 2017, Virginia health experts wrote in a case report on Thursday. Her symptoms appeared while she was gardening.
Just a day later, the woman was back at a hospital with more symptoms, such as difficulty swallowing water, shortness of breath, insomnia and anxiety, researchers said. The woman was treated for a suspected panic attack, and then was released. As soon as the woman got to her car, though, she couldn’t catch her breath and felt claustrophobic, so she went to the emergency room and was treated with anti-anxiety drugs a second time — then discharged again.
Her symptoms grew more severe May 8: An ambulance took her to a hospital with chest pain, worsening arm pain and anxiety. That night, she “became progressively agitated and combative and was noted to be gasping for air when attempting to drink water,” researchers wrote.
The hospital asked her family if she had been in contact with any animals, and that’s when doctors learned of her possible exposure to rabies, researchers said.
Her husband said a puppy had bitten the woman’s right hand six weeks before her symptoms cropped up, when the woman was traveling in India for a yoga retreat tour. After the bite, the woman and tour guide cleaned the wound, and left it at that. There was no further medical care, researchers said.
The woman was intubated on May 9 and rabies was confirmed by May 11. “Profuse oral secretions” set in on May 19, several days after doctors tried an experimental treatment that is rarely successful, researchers said. It’s called the “Milwaukee protocol,” and includes putting patients in a drug-induced coma, according to Scientific American.
The woman died on May 21. Once rabies symptoms appear in a person, the virus is nearly always fatal, according to Mayo Clinic. But the virus can be treated with a vaccine if caught early.
“I don’t believe that she was playing with the puppy, but the puppy was seen in the area and approached her,” said Dr. Julia Murphy, who wrote the report along with other health experts, according to NBC News.
The dog-specific strain of rabies was eradicated in the U.S. by 2004, but in much of the world it’s still common, killing nearly 60,000 people a year, according to the researchers.
That doesn’t mean rabies isn’t a threat in the U.S., though: It’s still found in small mammals like raccoons, bats and skunks, and even in black bears, as McClatchy reported earlier this month.
Researchers said the woman is the ninth person in the U.S. to die from the virus after catching it abroad in the last decade. The woman had no pre-existing health problems.
And she wasn’t the only person impacted: Public health officials determined 72 health workers may have been exposed to the virus, and all were officered vaccines, with eight declining, according to researchers. Hospitals and local health departments split the $235,000 all of the vaccinations cost.
Researchers said the woman lived at a “communal living facility” where she may have exposed four people to the virus: “three persons had direct contact with the patient’s saliva, and one person was bitten by the patient,” researchers wrote. All were told to get treated for exposure.
The 17-person yoga retreat in India ran from January to April 2017, and included people from Virginia, North Carolina, Maryland, Illinois, California and Spain, researchers said.
“Tour members confirmed that the patient was bitten by a puppy outside her hotel in Rishikesh, India,” the researchers wrote. “Three tour members in addition to the patient reported direct contact with the same puppy; two were determined not to have been exposed to infectious materials. One, a North Carolina resident, reported having been bitten on the leg.”
Researchers said a vaccine was recommended for the North Carolina resident.
Murphy warned that those traveling to countries where rabies is more common should take extra precautions.
“Travelers to India, which has the world’s largest incidence of dog-mediated human rabies deaths, are recommended to receive pre-travel rabies vaccination if they will be involved in outdoor activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites,” Murphy and other researchers advised. “In the case of the yoga retreat tour, given the extended length of the tour and the rural and community activities involved, pretravel rabies vaccination should have been considered.”