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Case Reports
. 2024 Oct 25;21(1):265.
doi: 10.1186/s12985-024-02536-2.

Adapted Milwaukee protocol for rabies treatment in a Brazilian indigenous child: case report

Dilceu Silveira Tolentino Júnior  1 , Maryana Santos Vasconcelos Marques  2 , Roberto Carlos de Oliveira  3
Affiliations
Case Reports

Adapted Milwaukee protocol for rabies treatment in a Brazilian indigenous child: case report

Dilceu Silveira Tolentino Júnior et al. Virol J. .

Abstract

Background: This case report describes the treatment of a 12-year-old indigenous Brazilian girl from the Maxakali group with rabies using the adapted Milwaukee Protocol.

Case presentation: The patient suffered a superficial bat bite on her right elbow, reported on April 5, 2022. Despite receiving immunoglobulin, a vaccine, and antiviral medications such as amantadine and sapropterin, the patient succumbed to the disease 25 days after hospital admission. The report highlights the inherent challenges in treating rabies due to the virus's neurotropic nature and the difficulties in delivering antiviral drugs to the central nervous system. The case underscores the need for early antiviral intervention and calls for more studies to validate and improve treatment protocols for rabies in vulnerable populations, particularly those with genetic and immunological susceptibilities like the Maxakali indigenous group.

Conclusion: The findings suggest that while the Milwaukee Protocol offers some hope, significant obstacles remain in achieving successful outcomes in rabies cases.

Keywords: Antiviral treatment; Case report; Indigenous child; Milwaukee Protocol; Rabies.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Indigenous child with suspected rabies awaiting transfer from the local referral hospital to another state referral hospital
Fig. 2
Fig. 2
Timeline showing the clinical evolution of an indigenous child treated by the Adapted Milwaukee Protocol, in April 2022
See this image and copyright information in PMC

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