In Asia, it is still controversial whether it is safe to inject a contaminated animal bite wound with a foreign protein such as equine or human rabies immune globulin, even though this is recommended by the World Health Organization. A prospective study of 114 severe animal bite wounds which were injected with equine or human rabies immune globulin revealed an overall incidence of gross infection of 11.4%. No matched control group of patients bitten by animals whose wounds were not injected with immune globulin could be studied in this environment with a high prevalence of canine rabies. The incidence of wound infection in lacerations inflicted by sharp objects and sutured under local anaesthesia was therefore studied prospectively in 100 Thai patients from a similar socio-economic milieu; it was found to be 13%. Wound infection was more common in animal bites and lacerations of the lower extremities. It is concluded that injecting a properly cleansed bite wound with equine or human rabies immune globulin is a safe practice and should be performed whenever there is a possibility that the biting animal might have rabies.

Animals↗

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Using the UV ParaLens adapter on a standard laboratory microscope for fluorescent rabies antibody detection.

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Antibodies, Viral↗

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Immune response to rabies vaccine in Alaskan dogs: failure to achieve a consistently protective antibody response.

Previous studies in Thailand and Tunisia have shown that one injection of dog pre-exposure rabies vaccine does not produce a lasting antibody titre in a significant group of animals. We therefore duplicated the Thai study in a small North American community using healthy, owned dogs. A tissue culture vaccine of known high antigenicity was given intramuscularly as one primary injection and antibody titres were determined by the rapid fluorescent focus inhibition test on days 14, 30, 60, 180 and 360. Titres were less than 0.5 i.u./mL in 27% of dogs bled at 2 months, 24% at 6 months, and in 33% one year after the primary vaccination. In rabies endemic regions, it may be hazardous to rely on the previous vaccine history of a biting dog when making post-exposure management decisions. A retrospective study of antibody levels in previously vaccinated dogs in North America also indicated that a single injection of vaccine often failed to result in adequate titres.

Animals↗

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Field study of an antigen-detection ELISA specific for Plasmodium falciparum malaria.

We field-tested a specific antigen-detection enzyme-linked immunosorbent assay (ELISA) based on the histidine-rich protein of Plasmodium falciparum, in a district hospital in Thailand. The test was simple to perform, takes less than 3 h to complete, can deal with batches of sera, be read visually, and was 98.05% sensitive and 96.22% specific. However, 3 of 154 microscopically identified P. falciparum cases gave false negative ELISA results. One of these patients had been admitted to hospital for P. falciparum malaria 3 months previously and all 3 came from hyperendemic villages and were thought to have had previous episodes of malaria, possibly resulting in high titres of circulating blocking antibody. The test was more sensitive when whole blood was frozen and thawed before testing. This test is promising but requires further refinement to eliminate false negatives before it can be used safely for screening acutely ill patients for falciparum malaria. The sensitivity of this ELISA appears to be sufficiently high to consider it as a tool for blood donor screening in regions with a high prevalence of P. falciparum carriers with low parasitaemia. There is at present no satisfactory routine screening method for large numbers of blood donors for malaria.

Adult↗

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Immune activation in human rabies.

Serum cytokines were compared by enzyme-linked immunosorbent assay among (i) 28 patients with rabies, (ii) 13 patients with non-fatal encephalitis due to other viruses, (iii) 16 patients with immune-mediated neurological diseases, and (iv) 15 patients with non-viral central nervous system infections and non-HTLV-I progressive spastic paraparesis. Levels of soluble interleukin 2 receptor (S-IL2R) were comparable in groups (i)-(iii). Fewer paralytic (1/6) than encephalitic (12/22) rabies patients had elevated S-IL2R. Only one patient with rabies and one with non-fatal viral encephalitis (group ii) had elevated S-CD8. Interleukin 6 (IL-6) was elevated in 5/22 rabies patients with encephalitis and in 0/6 paralytic rabies patients. Four individuals in groups (ii) and (iii) had elevated IL-6. Patterns of cytokine responses in group (iv) were similar to those in groups (i)-(iii). The results suggest defects in immune responsiveness in paralytic rabies.

Antibody Formation↗