1y ago

This is probably a dumb question, but if we eliminate the hydrophobia caused by rabies, would it increase the survival rate of active rabies?

I've been learning some about rabies and learned about rabies causing hydrophobia. This is just a theory, I'm not saying I know anything about this topic to be knowledgeable, but if we could get someone with rabies to not fear water, could they survive?

32 comments

No. You can fix the dehydration relatively easily by just giving the person liquid intravenously.
But the primary way rabies kills you is liquifying your brain, which is independent of how hydrated you are.
- So that's what The Shape of Water is about, never saw it.
  
  Nah that movie was about how human men are biologically flawed and that our cock and balls should be internal in some kind of clam shell like thing.
- Many organs function poorly when liquefied.
No. Rabies is destroying neurons, causing the symptoms. The hydrophobia is not literal fear of water (like phobias so often aren't) but a result of your brain being fried to the point where you have issues swallowing. If it were an issue of hydration, just IV fluids would be a given, and you would probably want IV access anyway.
Not a doctor or anything, though.
The "cure" for rabies is to treat it with a vaccine prior to symptoms appearing. The rabbies vaccine is 100% effective and you will not become symptomatic if you treat soon after the bite. The Milwaukee protocol has been tried and it's a last ditch effort for people who didn't get the vaccine shortly after the bite and are now showing symptoms. They don't even know if the Milwaukee Protocol is what prevented death or if the people it worked on were somehow resistant to rabies.
- Why can't we just get a rabies vaccine when we're kids, or every few years, like most other vaccines? Why does it have to be after the bite event?
  
  Because unless you're living and working in a high risk environment, there's no need for a human to go get a rabies vaccine because they can just avoid mammals that are acting strangely. It's not like it's airborne, you have to get a penetrating bite from a symptomatic animal to get it, so when that happens you just go to the doctor. You'd still likely get the vaccine even after a bite even if you had been previously vaccinated.
  
  Vets and people who work in animal shelters often get the rabies vaccines beforehand. But even if you have been vaccinated previously, you still have to get it again if you are bitten.
  
  ~~Considering that it has to go through the belly button, I'd rather not, thanks.~~
  This is apparently not the case anymore since the 1980s.
The Milwaukee Protocol is a treatment plan that is essentially a more advanced version of what you’re asking. The patient is put in a medically induced coma and then given antivirals and IV fluids, which avoids the issue of hydrophobia.
It got a lot of press because one person survived on it (a big deal given that rabies is a death sentence once symptoms appear) but this success hasn’t been reproduced with other patients. A paper on the protocol has a remarkably blunt title: Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned.
- and didnt they use it on that girl that survived cause she didnt report the bite until it was too late, so it was either try something dangerously crazy like Mulwaukee Protocol, or just die miserably?
  
  I guess whether this protocol should be abandoned, rather than iterated on to improve its chances of success, to me, depends on the effect the coma has on the patient's quality of life while the protocol is attempted. It's arguably more humane to put someone in a medically induced coma while they're still sane. If the protocol fails, the patient is at least not conscious while their brain is deteriorating.
  I'm gonna go watch House.
- Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned
  Well you got a better idea?
  I looked, and they don't.
  
  Yes. Get vaccinated before symptoms appear. If you don't, you are almost guaranteed to die no matter what intervention is attempted.
  
  Let them live out their last days with their family and die peacefully.
- It seems like this would be the most humane way to “treat” it, but maybe I’m missing something?
Unlikely. Rabies kills by infecting brain cells. This means they're converted into virus factories instead of doing brain things. That also causes swelling as an immune response, which further damages the brain. Both of these result in coma and death. Eliminating hydrophobia and increasing water consumption would not really help treat an infection (at least any more than treating any infection, which is to say, not very much on its own).

32 comments