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Hoping again for a miracle

Texas boy gets same treatment as Fond du Lac teen who survived rabies

By MARK JOHNSON and KAWANZA NEWSON
markjohnson@journalsentinel.com
Posted: May 11, 2006

Applying lessons learned from Jeanna Giese, the Fond du Lac teenager who became the first person in history to survive rabies without vaccine, doctors in Texas have put a teenage boy into a medically induced coma and given him a cocktail of drugs in a bid to save him from the deadly virus.

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Rodney Willoughby Jr., the pediatric infectious disease specialist who treated Giese at Children's Hospital of Wisconsin in Wauwatosa, said he has spoken by phone twice a day with one of the doctors working on the Texas case.

Willoughby, who was in Atlanta on Thursday for a meeting at the U.S. Centers for Disease Control and Prevention, said Texas doctors are using a modified version of Giese's treatment, including different amounts of some of the drugs. He confirmed that the boy was placed in a medically induced coma.

"They've had more problems with this patient than we had with Jeanna," Willoughby said. "He was much sicker than Jeanna was when he got to the ICU."

The Texas case marks only the fourth time the experimental treatment, or some version of it, has been used since Giese made medical history in the fall of 2004.

Three previous patients from Germany, India and Thailand all died, though their cases "have had tremendous weaknesses in one shape or form," Willoughby said.

Expanded knowledge

At the same time, Willoughby said that in the year and a half since Giese was treated, doctors have greatly expanded their knowledge of the biochemistry of rabies. He was able to give the doctors at Texas Children's Hospital in Houston a more detailed treatment plan than the one used for Giese. The plan anticipates numerous complications and medical scenarios and offers responses.

"What we know is that this is reversible, even at stages that would have been thought to be irreversible," said Willoughby, who also is an associate professor of pediatrics at the Medical College of Wisconsin.

By coincidence, the Wisconsin doctor flew to Atlanta on Thursday for a meeting of rabies experts aimed at developing a treatment package and detailed protocol that can be sent to hospitals quickly. The meeting was timed to prepare for bat season.

Like Giese, Zachary R. Jones, a high school student from Humble, Texas, appears to have gotten rabies from a bat and wasn't vaccinated afterward.

About a month ago, a bat entered Jones' room through an open window while he slept. He awoke and alerted his family, and a relative was able to let the bat out of the window.

"Apparently the family didn't know that he had been bitten," said Rita Obey, spokeswoman for the health department in Harris County, Texas, explaining why the boy was not vaccinated. "Bats' teeth are so small that they can bite you without leaving a mark and without you experiencing any pain."

Texas Children's Hospital, where Jones is being treated, was not releasing detailed information at the family's request. But he was listed in critical condition Thursday, two days after he was diagnosed with rabies. His early symptoms included a fever, headache and sensitivity to loud noises, Obey said.

Ann Giese, Jeanna Giese's mother, said she began praying for the young man Wednesday when she learned of his case. On Thursday, she posted a note on the Jones' family's Web page though the hospital.

"We never believed that Jeanna would die, even though they told us there was really no cure. Our faith kept us going throughout and still keeps us going," she wrote. "We had a lot of support from family and friends. God can do wonderful things; Jeanna is living proof.

"Please know that we will continue to pray for you, your family and the doctors and nurses who are taking care of your son. Know that God is working through them."

Ann Giese said she told her daughter about the doctors in Texas trying to duplicate her treatment.

"She said, 'I hope it works,' " Ann Giese said.

Survival without immunization

Before Jeanna Giese, there were only five documented cases of survival once clinical symptoms from rabies appeared, but each person had been immunized against the virus after being bitten.

On Sept. 12, 2004, Giese was bitten by a bat that entered St. Patrick Catholic Church in Fond du Lac. Giese, 15, and an animal lover, picked up the bat by the wings to help it from the church and was bitten on the left index finger. The bite left a tiny wound that her mother rubbed with peroxide.

But Giese received no medical treatment immediately after the bite. She was admitted to Children's Hospital on Oct. 18 with a fever of 102 degrees, double vision, slurred speech and jerking in her left arm.

Giese was diagnosed with rabies the next day, and her parents gave doctors permission to try a treatment never before attempted. The doctors had devised their own theory inspired by a medical paper that said an anesthetic called ketamine appeared to be effective against rabies in rats. They gave Giese a cocktail of drugs including ketamine, midazolam, ribavirin and amantadine.

Six days after starting on the drug cocktail, tests showed that Giese had an abundance of rabies-killing antibodies and doctors began to bring her out of the coma. To this day, doctors are unsure whether Giese survived because of the treatment or another factor, such as a weak strain of the virus.

Despite spending months in recovery and therapy, Giese was able to catch up with her classmates at St. Mary's Springs, a small Catholic high school in Fond du Lac.

Today her voice is a little lower and occasionally slurs but otherwise sounds normal. Next month she will go for her driver's license, and she is running and training for a return to sports.

"She's really hoping she can be back on the volleyball court next fall, so she'll be working pretty hard over the summer," her mother said.

Giese also has been working as a volunteer at a petting zoo in Fond du Lac.

Ann Giese said she could understand what the parents of the Texas boy are going through as he battles the virus that almost took Jeanna's life.

"You feel for the family," she said, "and are just hoping and praying it will work again."


From the May 12, 2006 editions of the Milwaukee Journal Sentinel
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