"Could this be rabies?"
That question, asked of infectious disease specialist Rodney Willoughby, MD, MCW professor of pediatrics by the transport-physician-on-duty at Children's Hospital of Wisconsin (Children's) on October 17, 2004, marked the moment that 15-year-old Jeanna Giese's life became inextricably linked with Dr. Willoughby's. Giese was suffering from fatigue, vomiting and difficulties with speech and coordination, and her patient history had revealed a bat bite suffered four weeks prior to her symptoms. She was transferred from St. Agnes Hospital in Fond du Lac, WI, and admitted to Children's the very next day after that fateful phone call.
"The last thing I remember was going to the emergency department in Fond du Lac," she recalls (since getting married, she is now known as Giese-Frassetto).
While rabies is rare in Wisconsin (four cases in the last 50 years), experts estimate that more than 55,000 people die across the globe from rabies each year. Dr. Willoughby sent samples of saliva, serum, spinal fluid, skin and hair to the Centers for Disease Control and Prevention (CDC) in Atlanta to rule out rabies as he investigated other potential bacterial or viral causes of her symptoms.
"Jeanna came in pretty much alert but rapidly deteriorated," Dr. Willoughby recalls. He spent every moment he could find researching the literature on rabies, as his medical school training on the topic started and ended with the fact that the disease was 100 percent fatal in humans who had not been at least partially vaccinated before the rabies virus entered the brain.
On the day after Giese was admitted to Children's, within an hour of the CDC confirming that she had rabies, Dr. Willoughby met with her full physician team to discuss their options. This included trying a new approach using what he had uncovered about the neuroscience of rabies and the positive effects of supportive care. After Giese's parents consented, she was placed in a medically-induced coma.
"We sedated her aggressively long enough for her immune system to start fighting the virus," Dr. Willoughby adds. In addition to using anesthetic drugs that wouldn’t suppress the immune system, the treatment plan included several antiviral drugs and other medications. After a week of biting his nails and planning for every conceivable scenario, tests showed that Giese had developed antibodies against rabies and that she had improved brain activity.
"While it was tremendously exciting, we did not know how complete her recovery would be," Dr. Willoughby notes. After Giese first awoke without sensation, she experienced a rapid recovery unusual for patients with brain disorders.
"Within a week, she was sitting up in bed and observing," Dr. Willoughby says. Giese-Frassetto still relies on Dr. Willoughby and her parents to fill in a memory gap regarding those early milestones.
"The first thing I remember after waking up was going to the cafeteria with my family to celebrate Thanksgiving, which was more than a month after I was transferred to Children's," she recollects.
"As soon as I could, I started physical, occupational and speech therapy there. The speech, especially, was so hard and so slow to come back," Giese-Frassetto says. Her rehabilitation process would continue for two years at Saint Agnes Hospital after she returned home to Fond du Lac.
"My friends and family were huge supporters," Giese-Frassetto adds. "No matter how painful it was, they helped me stay determined to do whatever it took to get better and live my life." She marked her physical recovery by the increasing speed with which she could walk on a treadmill during rehab sessions.
"Jeanna worked very hard at rehabilitation in order to become the first in her family to finish college, and now she is married with twins," Dr. Willoughby notes (Giese-Frassetto gave birth to fraternal twins in March 2016).
While Giese was the first documented patient to survive rabies without being vaccinated, she is not the last. Dr. Willoughby reports that 11 individuals have survived rabies after treatment with the "Milwaukee protocol," the treatment plan developed and refined over time from the steps which saved Giese's life back in 2004.
"I think it is awesome that it has worked for others and that Dr. Willoughby's team continues to make progress on improving the treatment," Giese-Frassetto says. She continues to do whatever she can to promote animal safety and rabies awareness by speaking at national and international rabies conferences, the annual Wisconsin Bat Festival, schools and other community organizations.
– Greg Calhoun
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