Failure of interferon alfa and tribavirin in rabies encephalitis

Abstract

Objective - To test the effect of interferon alfa and tribavirin (ribavirin) in patients with rabies encephalitis. Design - An open trial of chemotherapy and intensive care in patients with early rabies. Setting - The intensive care unit of a Bangkok hospital. Patients - Four conscious men with clinical rabies encephalitis. Interventions - Rapid virological diagnosis of rabies. Treatment with intravenous and intraventricular injections of high doses of lymphoblastoid interferon alfa in three patients and tribavirin in one patient. Intensive care was given throughout. Main outcome measures - Rabies infection confirmed by antigen detection and virus isolation. Rabies neutralising antibody and specific IgM sought in serum and cerebrospinal fluid. Interferon concentrations monitored before and during treatment in three patients. Results - Interferon alfa treatment produced high concentrations in serum and cerebrospinal fluid. All four patients died after 5 1/2 to 12 1/2 days of treatment with no evidence of virostatic or clinically beneficial effects from either treatment. Conclusion - Interferon alfa treatment is not effective in rabies encephalitis. The use of tribavirin warrants further study, possibly combined with new therapeutic methods.