METHODS: Interviews were conducted with family members to determine where the patient acquired rabies. Interviews were also conducted with the patient’s relatives, community members, and medical personnel who had contact with the patient to determine which individuals needed rabies post exposure prophylaxis (PEP). A medical chart review was conducted to determine the clinical course of the patient’s illness.
RESULTS: The patient was initially diagnosed as having Guillain-Barre syndrome. On the eighth day of hospitalization a family member recalled that six weeks previously the patient awoke at night with a bat on the bed, which she swatted away with her hand. Her husband examined her for bite wounds and found none. She did not seek medical attention. Her husband captured the bat and released it outside. Between two hospitals, 100 providers cared for the patient, with 22 receiving PEP. The patient’s husband and one other family member required PEP. Interviews conducted with 11 other family and community contacts resulted in two additional individuals receiving PEP.
CONCLUSIONS: This report describes the first known human rabies infection in a Wyoming resident and the first domestically-acquired case in the United States since 2012. The patient’s family had reportedly contacted several local government authorities regarding bats outside their home in the past. Also, the patient’s husband reported the incident to a local agency responsible for controlling weeds and invasive species. The individual at the agency taking the report was not aware of rabies risk from bats. These calls may have been missed opportunities to provide education about rabies, especially on bat exposures while sleeping, to the family. Without the history of bat exposure, clinicians would likely have not considered a rabies diagnosis. Knowledge of zoonotic diseases and obtaining an animal exposure history can be critical in the diagnosis of rabies and other diseases humans acquire from animals. Many of the health care providers who received PEP after caring for the patient reported direct skin or mucous membrane contact with potentially infectious fluids, contact that may have been avoided with adherence to Standard Precautions.