Close Encounter with a Bat
A cautionary tale about the risk of rabies.
By Marven Ewen, MD
One day while walking through a big box store, a customer was struck on the head by a flying bat (the mammal, not the wooden kind). He was concerned he might have contracted rabies from this contact and came to the ED.
He didn’t have any obvious marks on his scalp, but it was impossible to be completely sure he hadn’t been bitten. His tetanus immunization was up to date. Because he had potentially been bitten by a bat, rabies prophylaxis was administered.
This consisted of both a vaccine and rabies antibodies (rabies immune globulin). This results in both passive and active immunity. The antibodies will provide passive immunity, while the vaccine stimulates his immune system to produce active immunity.
Ideally, most of the immune globulin is supposed to be infiltrated into the area of the bite; however, in many cases this is not possible due to the limited amount of volume that can be injected into small tight spaces like the finger or when the site of the bite is uncertain. Typically, whatever amount can’t be injected into the wound area is given IM at a body site separate from where the first rabies vaccination is given.
The patient was then instructed to return for three more IM shots on days three, seven, and fourteen. This is a total of four shots of vaccine. The immune globulin is only given on the first visit.
Rabies is a fatal disease often carried by mammals such as bats, skunks, racoons, foxes and coyotes. It is interesting to note that it is not carried by rodents. Nobody likes rats for example, but they don’t carry rabies. Also snakes and other reptiles don’t carry rabies either. Some snakes of course can be problematic due to venom.
Less commonly, domestic animals can carry rabies; however, because rabies is fatal if not treated, all domestic dog/cat bites need to be evaluated for risk. This means any animal without up to date documented immunity that has bitten someone must be examined by a vet and quarantined for ten days.
If there are any signs of illness in that first ten days, the recipient of the bite must undergo rabies prophylaxis. Police should be notified to facilitate cooperation of the offending pet’s owner to supply this documentation. Don’t just take someone’s word for it.
Alternatively, an animal can be euthanized and its brain assessed by a lab equipped. This is generally not necessary and not as easy to arrange. If a domestic animal is unable to be captured and quarantined, then it must be assumed the animal is rabid and the patient will get rabies prophylaxis.
Finally, it should be noted that bats’ teeth are very small, and sometimes a bite may not even be felt. Therefore, any contact with a bat should be considered a risk and managed appropriately.
If you wake up and find a bat in your room, assume you were bitten at some point during the night and get treatment.
More from The Allied Times
Misophonia An uncontrollable reaction to sounds.By Jenny Ewen, BA, NREMTEditor-In-ChiefHave you ever had someone tell you stop chewing so loudly? While you might have immediately assumed that person was just being overly sensitive, there’s actually a name for the disorder where certain sounds trigger a negative response: misophonia.People who have misophonia have an uncontrollable reaction…
Infectious Mononucleosis The “kissing disease” lingers on.Here’s what you should know about it.By Jenny Ewen, BA, NREMTEditor-In-ChiefWe all remember “the kissing disease” from adolescence, which is known as infectious mononucleosis, or mono. Since the virus spreads through saliva, it can be shared from kissing, but also from an uncovered cough or sneeze, or sharing food…
Scared To Death It can actually happen with this rare heart condition.By Marven Ewen, MDMedical DirectorOn a busy Sunday evening in the ED, an elderly man came in to be “checked out.” His story was that earlier that day he had been snacking on some peanuts while watching the football game.He choked on some of…
The Deer Hunter When mixing whiskey and hiking leads to the ER.By Marven Ewen, MDMedical DirectorIn the EMS field, it is not uncommon to have to care for intoxicated patients. Alcohol is often a factor in trauma. We sort of kept an informal record of the highest alcohol level we had seen in a patient.…
Hashimoto’s Disease This autoimmune disorder is the most common cause of hypothyroidism.By Jenny Ewen, BA, NREMTEditor-In-Chief Overview Hashimoto’s disease (also known as Hashimoto’s thyroiditis) is classified as an autoimmune disorder since it’s caused by the immune system attacking the thyroid to the point where it becomes damaged. The thyroid is a small butterfly shaped gland…
ADHA Inattention and hyperactivity/impulsivity that even continues into adulthood.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverview Most children (and even some adults) occasionally have difficulty focusing. Those who have ADHD continually have problems with concentration, and growing into adulthood doesn’t mean leaving those symptoms behind – the symptoms continue and can even become more severe. Attention-deficit/hyperactivity disorder (ADHD)…