A Virginia woman bitten by a dog while on a yoga retreat in India was confirmed to have contracted rabies that led to her death in 2017, according to a new report from The Centers for Disease Control and Prevention (CDC). The 65-year-old woman’s hand was bitten during her stay, and after six weeks, she started experiencing pain. After initially being misdiagnosed with a panic attack, the woman tested positive for rabies a virus she hadn’t ever been vaccinated against. She became the ninth person since 2008 to die from rabies in the U.S. after exposure to the virus abroad, according to the CDC.
The woman’s initial symptoms began May 3, 2017, around six weeks after the incident, BuzzFeed reported. She went to an urgent care facility three days later, complaining of pain in her right arm, and the report noted that she was diagnosed with carpal tunnel syndrome. On May 7, the patient went to a hospital with symptoms including insomnia, anxiety, and shortness of breath, and she voiced worry about “exposure to a toxic substance.” The health professionals "presumed" it was a panic attack and discharged her after providing her with lorazepam, a drug widely used for anxiety disorder treatment. The patient experienced shortness of breath and claustrophobia shortly after going into her car, and she returned to the hospital’s emergency department, where she was administered an additional dose of lorazepam and discharged again.
On May 8, the patient arrived via ambulance to the emergency department of another hospital, where she exhibited shortness of breath, discomfort in her chest, and a progressive prickling and burning sensation in her right shoulder and arm. Throughout the day, her symptoms expanded to “gasping for air” when she tried to consume any water. It was at this point that hospital staffers asked her family whether she’d been exposed to any animals, and the patient’s husband said that a puppy had bit her on the right hand when she was in India, after which she’d cleaned the bite and didn’t seek any following medical attention. The Virginia Department of Health was notified of her case on May 9, and on May 11, she was confirmed as having contracted rabies. After experimental treatment failed, the patient’s family withdrew further medical support, and she died on May 21.
A public health investigation recommended that 72 people who’d been exposed to the patient initiate treatment for potential exposure to rabies via post-exposure prophylaxis (PEP), which is the only current treatment that can keep exposed persons from getting rabies if given prior to onset of symptoms. The total treatment cost for exposure cost roughly $235, 000, according to the CDC report.
In the U.S., only 1 to 3 cases of humans contracting rabies are reported annually, according to a separate report from the CDC. While rabies is largely under control in domestic pets like dogs and cats in the U.S., the virus circulates via wild animals like bats, raccoons, and skunks. Initial rabies symptoms can look just like the flu, and then progress to symptoms of anxiety, agitation, hydrophobia (fear of water), or hallucinations. Once later symptoms set in, it causes swelling in the brain and is nearly always fatal, according to Mayo Clinic.
The CDC cautioned that the case “highlights the importance of prompt rabies diagnosis to minimize health care–associated exposures” and also recommended that international travelers follow precautions like getting suggested vaccinations and preventative healthcare prior to travel.