Human rabies - Kentucky/Indiana, 2009.

On October 19, 2009, clinicians from Kentucky contacted CDC regarding a suspected case of rabies in a man from Indiana aged 43 years. This report summarizes the patient's clinical presentation and course, the subsequent epidemiologic investigation, and, for the first time, provides infection control recommendations for personnel performing autopsies on decedents with confirmed or suspected rabies infection. Before the patient's death on October 20, a diagnosis of rabies was suspected based on the history of acute, progressive encephalitis with unknown etiology. Preliminary serology results on antemortem serum samples detected rabies virus-specific antibodies. Because local pathologists were concerned about the biosafety risk posed by infectious aerosols at autopsy and potential contamination of autopsy facilities, the Kentucky Department for Public Health (KDPH) asked CDC staff members to travel to Kentucky and perform an autopsy to confirm the diagnosis and assist with the epidemiologic investigation. Testing of autopsy samples was conducted at CDC and detected rabies virus antigens in brainstem and cerebellum. Rabies viral RNA was isolated and typed as a variant common to the tricolored bat (Perimyotis subflavus). Although rabies virus transmission from organ or tissue transplant has been documented rarely, transmission of rabies virus to persons performing autopsies has not been reported. Autopsies can be performed safely on decedents with confirmed or suspected rabies using careful dissection techniques, personal protective equipment, and other recommended precautions.