Rabies victim bit nurses in despair

A DISTURBING insight into the final days of the first Briton to die from rabies in 100 years was revealed yesterday by the doctor who fought for more than a week to save David McRae.

Driven to despair by the disease, caused by a bite from a bat, the dying man injured two nurses by biting and scratching them.

"It was not his fault, but there was concern for the staff," said Dr Dilip Nathwani, a consultant in infectious diseases at Ninewells hospital, Dundee.

Speaking for the first time since the death of the renowned artist, climber and scientist in November last year, Dr Nathwani told a meeting of colleagues at Ninewells of his desperate, and vain, race against time to identify the illness.

Later, he said: "I have asked myself if we could have done more, but we did all we could. It is unlikely we will ever see another such case."

Mr McRae, 55, who lived in Guthrie, Angus, contracted European bat lyssavirus Type 2a rabies after being bitten by a Daubenton bat.

The Englishman, with an international reputation in his fields, had travelled to the world’s most dangerous places.

But, in Guthrie, he indulged his love of bats and monitored the local population for Scottish Natural Heritage (SNH).

Months before his death, he was bitten on the ring finger of his left hand, but was unaware of the danger because the UK is free of terrestrial rabies.

It is also the reason why he was not vaccinated against bat bites, which at the time was the recommendation of SNH. Vaccination is now obligatory.

And unknown to Mr McRae, the rabies infection was the cause of painful stiffness in his arm for which a GP prescribed anti-inflammatory drugs.

But later he was admitted to hospital, where doctors were baffled by his "unexplained neurological illness".

According to Dr Nathwani, they were forced to go on a "fishing expedition" and administer "a whole bunch of tests" in order to uncover the cause of Mr McRae’s symptoms.

Brain scans revealed nothing and he was tested for encephalitis-related illnesses.

It was on his fourth day in hospital that Mr McRae attacked the nurses, spitting blood and saliva on them.

The uncharacteristic behaviour made doctors realise they were dealing with a rare condition.

Dr Nathwani said: "There was concern for the risk to staff, even before the rabies diagnosis.

"The scratches and bites were worrying. If we waited [for a positive diagnosis] and in three months’ time two members of staff became unwell, when potentially we could have prevented it, I think we would have done the wrong thing."

However, the nurses did receive treatment, which prevented infection, and they suffered no ill effects.

But the attack had proved Mr McRae’s personality was changing.

Dr Nathwani added: "The problem was Mr McRae’s belief that there had never been rabies among Scottish bats and he had not handled bats outside Scotland.

"It is like how a sewerage worker would not expect to get typhoid.

"That probably gave him that extra reassurance, and also explains why he did not seek treatment after the bite."

However, eventually, there was the realisation that a bat may have caused the disease.

A young doctor spotted the healed bite wound, which flagged up the possibility of rabies, but by that time Mr McRae was in a coma.

Dr Nathwani said the bite mark, coupled with the news that the patient had recreational and occupational exposure to bats, but had not opted for protective vaccination, led them to rabies.

In his lecture yesterday in the hospital, Dr Nathwani said it was important at the time to avoid public panic.

He said he had backed a decision by his director of public health to reveal the case despite "phenomenal public and media interest".

He added there was an "hysterical" response from the public and among some of his own staff after it was confirmed Mr McRae was suffering from a paralytic form of the disease, which affects the body from the feet up and manifests symptoms of fever, hallucinations and fear of water.

Rabies is an infection of the nervous system caused by a virus, usually transmitted by an animal bite.

It was a tragically unlikely end for a man who had lived with danger, travelling to Patagonia, Papua New Guinea and Nepal to paint "lost" tribes.

In Guthrie, he was a "loveable eccentric", known as the "batman".

Dr Nathwani said: "We have learned, and the chances of it happening again are rare. When a patient presents with these symptoms, doctors must explore the bat connection.

"It is now obligatory for all workers to be vaccinated, so that reduces risk.

"If bitten, they should be immediately vaccinated. And if the public see a bat they should leave it alone."

He added: "I could work for the rest of my life and never see a repeat of this tragic case."