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Potential Confounding of Diagnosis of Rabies in Patients with Recent Receipt of Intravenous Immune Globulin.

Abstract Rabies is an acute encephalitis that is nearly always fatal. It is caused by infection with viruses of the genus Lyssavirus, the most common of which is Rabies lyssavirus. The Council of State and Territorial Epidemiologists (CSTE) defines a confirmed human rabies case as an illness compatible with rabies that meets at least one of five different laboratory criteria.* Four of these criteria do not depend on the patient's rabies vaccination status; however, the remaining criterion, "identification of Lyssavirus-specific antibody (i.e. by indirect fluorescent antibody…test or complete [Rabies lyssavirus] neutralization at 1:5 dilution) in the serum," is only considered diagnostic in unvaccinated patients. Lyssavirus-specific antibodies include Rabies lyssavirus-specific binding immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies and Rabies lyssavirus neutralizing antibodies (RLNAs). This report describes six patients who were tested for rabies by CDC and who met CSTE criteria for confirmed human rabies because they had illnesses compatible with rabies, had not been vaccinated for rabies, and were found to have serum RLNAs (with complete Rabies lyssavirus neutralization at a serum dilution of 1:5). An additional four patients are described who were tested for rabies by CDC who were found to have serum RLNAs (with incomplete Rabies lyssavirus neutralization at a serum dilution of 1:5) despite having not been vaccinated for rabies. None of these 10 patients received a rabies diagnosis; rather, they were considered to have been passively immunized against rabies through recent receipt of intravenous immune globulin (IVIG). Serum RLNA test results should be interpreted with caution in patients who have not been vaccinated against rabies but who have recently received IVIG.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title mmwr. morbidity and mortality weekly report
Publication Year Start




PMID- 29420464
OWN - NLM
STAT- MEDLINE
DCOM- 20180213
LR  - 20180222
IS  - 1545-861X (Electronic)
IS  - 0149-2195 (Linking)
VI  - 67
IP  - 5
DP  - 2018 Feb 9
TI  - Potential Confounding of Diagnosis of Rabies in Patients with Recent Receipt of
      Intravenous Immune Globulin.
PG  - 161-165
LID - 10.15585/mmwr.mm6705a3 [doi]
AB  - Rabies is an acute encephalitis that is nearly always fatal. It is caused by
      infection with viruses of the genus Lyssavirus, the most common of which is
      Rabies lyssavirus. The Council of State and Territorial Epidemiologists (CSTE)
      defines a confirmed human rabies case as an illness compatible with rabies that
      meets at least one of five different laboratory criteria.* Four of these criteria
      do not depend on the patient's rabies vaccination status; however, the remaining 
      criterion, "identification of Lyssavirus-specific antibody (i.e. by indirect
      fluorescent antibody...test or complete [Rabies lyssavirus] neutralization at 1:5
      dilution) in the serum," is only considered diagnostic in unvaccinated patients. 
      Lyssavirus-specific antibodies include Rabies lyssavirus-specific binding
      immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies and Rabies
      lyssavirus neutralizing antibodies (RLNAs). This report describes six patients
      who were tested for rabies by CDC and who met CSTE criteria for confirmed human
      rabies because they had illnesses compatible with rabies, had not been vaccinated
      for rabies, and were found to have serum RLNAs (with complete Rabies lyssavirus
      neutralization at a serum dilution of 1:5). An additional four patients are
      described who were tested for rabies by CDC who were found to have serum RLNAs
      (with incomplete Rabies lyssavirus neutralization at a serum dilution of 1:5)
      despite having not been vaccinated for rabies. None of these 10 patients received
      a rabies diagnosis; rather, they were considered to have been passively immunized
      against rabies through recent receipt of intravenous immune globulin (IVIG).
      Serum RLNA test results should be interpreted with caution in patients who have
      not been vaccinated against rabies but who have recently received IVIG.
FAU - Vora, Neil M
AU  - Vora NM
FAU - Orciari, Lillian A
AU  - Orciari LA
FAU - Bertumen, J Bradford
AU  - Bertumen JB
FAU - Damon, Inger
AU  - Damon I
FAU - Ellison, James A
AU  - Ellison JA
FAU - Fowler, Vance G Jr.
AU  - Fowler VG Jr.
FAU - Franka, Richard
AU  - Franka R
FAU - Petersen, Brett W
AU  - Petersen BW
FAU - Satheshkumar, P S
AU  - Satheshkumar PS
FAU - Schexnayder, Stephen M
AU  - Schexnayder SM
FAU - Smith, Todd G
AU  - Smith TG
FAU - Wallace, Ryan M
AU  - Wallace RM
FAU - Weinstein, Susan
AU  - Weinstein S
FAU - Williams, Carl
AU  - Williams C
FAU - Yager, Pamela
AU  - Yager P
FAU - Niezgoda, Michael
AU  - Niezgoda M
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20180209
PL  - United States
TA  - MMWR Morb Mortal Wkly Rep
JT  - MMWR. Morbidity and mortality weekly report
JID - 7802429
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Rabies Vaccines)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - False Positive Reactions
MH  - Female
MH  - Humans
MH  - Immunization, Passive
MH  - Immunoglobulins, Intravenous/*administration & dosage
MH  - Lyssavirus/isolation & purification
MH  - Male
MH  - Middle Aged
MH  - Rabies/*diagnosis
MH  - Rabies Vaccines/administration & dosage
MH  - Rabies virus/isolation & purification
MH  - Young Adult
PMC - PMC5812472
COIS- Vance G. Fowler, Jr. reports grants from MedImmune,
      Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance,
      Novartis, Cubist/Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect,
      Karius, and Genentech; consultant fees from Pfizer, Novartis, Galderma, Novadigm,
      Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa,
      Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy,
      Janssen, xBiotech, and Contrafect; educational fees from Green Cross, Cubist,
      Cerexa, Durata, Theravance, and Debiopharm; royalties from UpToDate; and has a
      Sepsis Diagnostics patent pending. No other conflicts of interest were reported.
EDAT- 2018/02/09 06:00
MHDA- 2018/02/14 06:00
CRDT- 2018/02/09 06:00
PHST- 2018/02/09 06:00 [entrez]
PHST- 2018/02/09 06:00 [pubmed]
PHST- 2018/02/14 06:00 [medline]
AID - 10.15585/mmwr.mm6705a3 [doi]
PST - epublish
SO  - MMWR Morb Mortal Wkly Rep. 2018 Feb 9;67(5):161-165. doi: 10.15585/mmwr.mm6705a3.