Bat Scratch Fever

Call it a "Really Stupid Undomesticated Animal Trick."

While roughing it in a northern Arizona campsite south of the Village of Oak Creek last month, a group of unidentified campers discovered a bat lying on the ground. Rather than simply steering clear of the obviously disabled creature -- a healthy bat would never allow a human to handle it -- the campers picked up the animal and began tossing it around.

"As unbelievable as it sounds, these people basically adopted this sick bat as a camp mascot for three days," says Michael Murphy, spokesman for Arizona's Department of Health Services. "Not only were they handling it themselves, but they apparently were showing it to other people in the area."

The state agency learned of the situation only after one of the campers sought treatment for a bat bite.

Hearing news accounts of the incident after the state health organization issued an APB for anyone who might have come in contact with the diseased bat, many people rolled their eyes. Clearly, these campers needed to have their heads examined.

In reality, however, it was the bat that had its head examined. Or, more precisely, its brain.

Several days later, when a state microbiologist studied slices of the decapitated bat's brain under a microscope, everyone's worst fears were confirmed. The tissue was found to be infected with rabies, the deadly virus that attacks the central nervous system of mammals.

As a result of the discovery, the camper who'd been bitten by the bat and eight others known to have had contact with the creature began a series of rabies shots. Fortunately, the treatment enabled them to escape what one public health official has deemed the most awful type of death imaginable.

"A colleague at the Centers for Disease Control once said that if he had to pick the most horrible way to die, it would be rabies," says Ron Cheshier, the microbiologist who examined the rabid bat. "You go psychotic, you get spasms in your throat, you get very anxious and, ultimately, you die of respiratory and cardiac arrest. Once a human begins to show symptoms of the disease, rabies is virtually always fatal."

A disease that is both fascinating and repulsive -- folklorists believe that the legendary werewolf may actually have been a victim of the virus -- rabies continues its strange stranglehold on America's imagination. Particularly Arizona's imagination, after a dry summer that has driven potential rabies carriers from bats to bears into metropolitan Phoenix.

But epidemiologists confirm the fear -- animal rabies is on the rise. Events like those in Oak Creek Canyon have led health officials to try to educate an amazingly ignorant public. Veterinarians are urging pet owners to vaccinate their cats for rabies. But not every animal can be vaccinated -- and people do still die of rabies.

Ron Cheshier is one man who faces rabies every day -- and has lived to tell the tale.

As chief microbiologist for the Arizona Department of Health Services laboratory, Cheshier would have made a great guest on the now-defunct game show What's My Line?. If that quiz program were still on the air, he'd surely stump the panel with a thumbnail description of one particularly ghoulish aspect of his livelihood: "examines the brains of dead animals suspected of carrying rabies."

Located in the DHS building at 15th Avenue and Adams (another lab in Tucson handles southern Arizona cases), Cheshier's department is a showcase for rabies in its many shapes and forms. Scattered on the walls is a variety of framed bat carcasses, including a spooky-looking Mexican vampire specimen with a long, siphonlike snout used to drain blood from host animals.

In the hallway, a bulletin board is covered with yellowing 8-by-10 glossies, a hit parade of wild-eyed, frothing canines in the final throes of rabies. Nearby, a large map of Arizona is studded with multicolored pushpins representing cases in which the rabies virus has been positively identified in animals. It is not a comforting sight. While movies like Old Yeller have led most people to think of rabies as a rural phenomenon, the majority of the pins are jammed into the Phoenix metro area, with a secondary cluster in Tucson, and relatively few scattered through less-populated areas of the state.

Down the hall and around the corner is a plaque identifying the "Necropsy," a small autopsy lab off-limits to everyone but Cheshier and a handful of technicians, all of whom have been inoculated with the rabies vaccine. This is where -- clad in white coats, gloves and protective masks -- they dissect hundreds of animal heads that come under their scrutiny annually.

Realizing that other workers in the department might not relish an accidental glimpse of a technician boring into a cat's skull with a bone saw, someone has covered the window in the door with tissue paper. A thoughtful gesture, the semi-opaque covering shields Cheshier's grisly handiwork from the faint of heart, while still allowing the morbidly curious to get a fuzzy peek into the tiny chamber outfitted with a refrigerator, sink and mini autopsy slab.

And although Halloween is just around the corner, the decorations pasted all over the lab's door have nothing to do with the upcoming holiday. Says one employee, "Oh, those paper bats? They're here all year round."

Although Cheshier's job entails a host of other health-related diagnostic duties, it isn't surprising that he currently has rabies on the brain.

In addition to the Oak Creek scare, word has just reached his office that a 49-year-old man has just died from rabies in a Sacramento hospital, apparently unaware that he'd been bitten by a bat. Noteworthy for its rarity (the death was the first rabies fatality in California in five years, and only the 28th in the United States in the past 10 years), the case once again points out the danger of interacting with wildlife, either intentionally or accidentally.

Arizonans have been lucky. "The last human rabies case in this state was in 1981," says Cheshier, "and that was imported."

According to the microbiologist, the victim apparently contracted the disease from an animal bite in Mexico before returning to the United States. (It can take from five days to a year for rabies to show up in humans; two months is the average.)

"In a case like that, where there's no hope of finding the animal and the person doesn't realize there's been contact until the onset of symptoms, there's absolutely nothing that could be done to save him."

Had the same scenario unfolded in the States, that man might still be alive today. Ideally, says Cheshier, someone who's been bitten by an animal will immediately notify authorities, who will assess the danger of the situation. If the animal is a domestic dog or cat, whose owners can provide current vaccination records, the animal may simply be quarantined for observation for a number of days.

But if someone is bitten by an undomesticated animal, say a skunk or a bat, authorities will try to find the animal for testing. (Because rabid animals that attack people are usually near death themselves, they're not nearly as hard to find as one might imagine.) If the animal cannot be found, the victim should immediately seek medical treatment. But if the animal can be found, authorities will kill it, cut its head off and send it to the state health service lab.

Because the presence of the disease can only be established by scrutinizing brain tissue samples, Cheshier's chore typically involves scalping the animal, then cutting into its skull with a bone saw. Tissue is then affixed to glass slides, then treated with a solution that glows an apple-green color if the rabies virus is present when viewed under ultraviolet light.

Since Cheshier joined the department 17 years ago, he and his small staff have examined the gray (and sometimes apple-green) matter of thousands of potential rabies carriers.

Last year, his office received the heads of 1,286 animals from around the state. In addition to bats (the main source of human rabies in the United States), the bodiless menagerie included cows, horses, raccoons, skunks, a bear, a mule and even a potbellied pig. Of those, only 43 animals tested positive for the disease. And while it's unlikely that the Phoenix lab will hit those numbers this year (in the first nine months of 2000, only 20 cases of rabies have been discovered), an inordinate number of rabies cases discovered by the Tucson lab leads experts to believe that animal rabies is on the rise within the state.

And until the end of a drought that is sending record numbers of wild animals into populated areas in search of food -- about a dozen bears have been spotted in the Valley in recent months -- observers predict that Arizona's rabies problems have just begun to bite.

"In terms of positive rabies tests, what we're seeing now is just the tip of the iceberg of what's routinely going on in wildlife areas."

So says Craig Levy, manager of the state Department of Health Services Vector-Borne and Zoonotic Disease Section, who explains that, as a result of the drought, the public is finally seeing a lot of rabid animals whose disease would otherwise go unreported.

"If a rabid bat flies over Coconino County and falls out of the sky," he says, "you're rarely going to hear about it because the bats usually wind up dying out in the middle of nowhere."

Unfortunately, says Levy, unattended deaths are a rarity when a bat happens to expire in a densely populated area. "If the same thing happens in Phoenix or Tucson, it's probably going to land in someone's yard where it will be discovered by somebody or their pet."

In one case that came to the department's attention a few years back, the diseased bat actually became the "pet." After finding a grounded bat, a young boy became so enamored of his new pal that he hauled the ailing creature to school for show-and-tell, took the animal to church and even kept it for so long after its death that its body was practically mummified before someone convinced him to have it examined for rabies. The test result? Positive.

Public health officials have never found it necessary to mount major campaigns to warn people about the dangers of playing with rattlesnakes or snacking on toadstools. So why all the foolish behavior with bats?

Choosing his words carefully, Levy chalks it up to "ignorance."

"Bats are very interesting critters and they're certainly nice to have around from the standpoint of insect control. But they're certainly nothing for humans to play with. I think part of the problem is that people see these nature programs on TV, but the shows rarely mention the downside."

"I guess people see these cute furry little faces and can't resist picking them up," he theorizes. "If these same people had seen a sick skunk staggering out of the woods, nobody would go near it, yet they think nothing of picking up a bat that quite possibly has rabies. It's strange."

If it's hard to fathom why anyone would handle a sick bat, it's even more difficult to imagine the horror of somebody who learns too late that they've been bitten by a rabid bat.

In fact, Levy reports that over the past few years, the majority of humans who've died of rabies in the United States were unaware they'd even been infected until the onset of symptoms.

Such was the case in 1995 when a 4-year-old girl in Washington state inexplicably began suffering from feverish hallucinations -- a classic symptom of human rabies -- before lapsing into a brain-dead coma the day before her death. When baffled doctors asked if she'd been exposed to rabies, her parents reported that a dead bat had been found in her bedroom several months before. But when they found no bite marks on her body, they buried the bat in the yard and promptly forgot about the incident. When the bat was exhumed, health officials found it had been infected with rabies.

And although investigators may never know for certain, they suspect that an undetected bat bite was responsible for the death of the country's latest rabies victim last month. Complaining that his limbs were so numb he was unable to pick up a coffee cup, the 49-year-old northern California man made multiple trips to the emergency room before doctors began to suspect rabies. "Whatever is in my body is taking over, and I feel I am going to die," he told his wife. Heavily sedated with morphine and on a ventilator, he died a week after the symptoms first appeared.

"Bats have small mouths and small teeth," warns Levy. "Even if they do chomp down on you, you may not feel it and they may not leave a physical wound." As a result, he says, the Centers for Disease Control urge anyone who finds a bat in their home to call authorities immediately.

"This time of year, bats are migrating, and you're going to find them in your carports and whatnot," explains Levy. "Leave 'em alone! We don't want you to call us if you've got one roosting in a carport. But a grounded bat? That's a whole different ballgame."

When Cathy Eden and her younger brother were exposed to rabies as children, there was no doubt they'd been bitten. While playing in the yard of their Phoenix home, Eden and her five-year-old brother were attacked by a cat that dug its claws into her brother's back and somehow drew blood during a swipe at her.

That was in 1954, when rabies treatment involved a long series of painful shots, usually administered in the stomach.

Now the director of the state Department of Health Services, Eden says that thanks to childhood naiveté and calm parents, she blissfully had no idea what she was in for. "I was 7," she laughs. "A 7-year-old doesn't know about rabies, and my parents handled it so well, I didn't know there was anything to be worried about."

According to Eden, Phoenix didn't have rabies testing facilities at that time. As a result, the cat's head had to be shipped out of state for results, a process that took two weeks. (Results now come back within a day.) During the interim, says Eden, the local press had a field day as health officials publicly debated the wisdom of waiting so long before treating the children. When the results came back negative, her folks were so relieved that the family decided to spend a few days in northern Arizona to get away from the media hoopla.

Although exact details are vague, someone took another look at the cat's test -- and realized the animal actually was infected. When the mistake was discovered, health officials were dispatched to find Eden's family so the children could begin the dreaded anti-rabies injections. As Eden recalls it, she and her brother had to go to the doctor's office every day for several weeks.

Laughing, Eden dismisses the notion that her brush with rabies has anything to do with her career path. "I will tell you, though, that after all these years, my brother still has a hard time with needles."

That was then, this is now. And although human rabies is every bit as incurable as it was thousands of years ago, considerable progress has been made in preventive treatment. The old anti-rabies regimen -- a horrific process that often involved drawing a circle on a patient's stomach, then dividing that into 28 pie piece-shaped sections that would receive one injection apiece over a four-week interval -- hasn't been used since the early '80s. In its place is a variety of vaccines, most of them requiring only five injections in the arm or derrière, plus a booster shot.

Not inexpensive, the combined cost of the shots and doctor's fee (roughly $1,200 to $2,000) may cause even the most rabid bat enthusiast to have second thoughts about picking up a wounded winger.

Still, an ounce of prevention is worth a pound of anti-rabies vaccine, causing Craig Levy to wonder why many cat owners still refuse to have their pets vaccinated. (Although Arizona law requires rabies vaccinations for dogs, they are not mandated for felines.)

Echoing the sentiments of other health-care authorities, Levy says, "My feeling is that cats should be vaccinated. Cats are every bit as susceptible to rabies as dogs and may actually have more opportunities to play with bats than a dog does. I hate to say it, but a lot of people look at dogs and cats totally differently as far as a pet goes. Dogs are often seen as a companion animal, while the cat is viewed as semi-feral."

Levy hopes that cat lovers who are loath to spend the money to have their cat vaccinated will think twice if they consider the big-picture economics of what happens should their pet bite somebody or come in contact with a bat.

"If your cat is a vaccinated animal and is current in its vaccinations, you may be able to quarantine it in your own home for 45 days," he points out.

And the alternative? "We can quarantine the animal at your expense for up to six months in an approved facility. Either that or euthanize."


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