A coroner heard that the & # 39; extremely rare & # 39; a father's death from rabies occurred after doctors told him that bite the cat in his finger was no problem and he had to buy some & # 39; anti-itch & # 39; cream.
The 58-year-old contracted the deadly disease during his vacation in Morocco, when he was one of the people who was bitten on the street by a rabid cat.
Full-time carer Omar Zouhri died at the Oxford hospital within days of doctors realizing that he & # 39; furious rabies & # 39; had – a disease that has been eradicated in the UK since 1902.
Coroner Darren Salter from Oxfordshire said: & # 39; This is of course a very sad thing, but it is also an extremely rare thing here in the UK. & # 39;
He had previously been told about the & # 39; anti-itch cream & # 39; jungle in the walk-in clinic that Mr. Zouhri visited and about a second blunder in which a doctor claimed that rabies came from dogs instead of cats.
Omar Zouhri, 58, from Aylesbury, was bitten by the rabid animal while on vacation with his family on 31 August last year. This is the last photo of him at the hospital shortly before he died
An investigation at Oxford learned that Mr Zouhri had contracted rabies on 31 August last year when he and his 12-year-old son were outside a family home in the northern city of Meknes, Morocco, and a rabid cat jumped at him and left his teeth in his lower right finger.
The investigation showed that the 58-year-old wore rabies from that moment on, but it was not until October 28 that & # 39; the dice was rolled & # 39; when he experienced symptoms of & # 39; furious rabies & # 39; began to report – itching, pain and muscle twitching – showing that the virus had already entered his central nervous system, making any treatment ineffective and ending his fate.
Zouhri was classified by Public Health England as a risky case and received the only known rabies treatment from 12 October.
However, Mr. Salter pointed to a failure at Stoke Mandeville Hospital in Buckinghamshire, which meant that Mr. Zouhri was diagnosed as rabies five days later than he should have been.
August 31, 2018: Omar Zouhri is bitten by a rabid cat in Meknes, Morocco, one of the seven people attacked.
& # 39; Immediately afterwards & # 39;: He went with a boy who was bitten to a local hospital in Morocco and got a tetanus shot.
Shortly thereafter he went to a Moroccan police station to complain about the unhelpfulness of the hospital doctors. He said they had not administered anti-rabies drugs.
1st of September: He buys antibiotics without a prescription at a pharmacy in Morocco
5 September: Mr Zouhri returns to Aylesbury, Bucks
& # 39; Early October & # 39;: Mr Zouhri receives a message from Morocco that the young boy has died.
October 6: Mr Zouhri attends Stoke Mandeville A&E and is seen by nurse Menchie Mallari. She asked a plastic surgeon about the bite, who advised: "Rabies can get the most from dogs, not cats".
12 October: He is starting rabies vaccination. Treatment is only effective if four doses of immunoglobulin are administered over a 21-day period.
October 27: Mr Zouhri was still & # 39; fit and well & # 39 ;, according to his widow.
October 28: Mr Zouhri visits a doctor's office outside office hours to complain about pain and itching, but was told that he had no rabies and was instructed to try anti-itch cream.
29 October: He goes to his doctor's office and tells Dr. Rachel Moghal that the pain radiates his arm & # 39 ;.
October 31st: Mr Zouhri returns to Stoke Mandeville Hospital, where he is seen by GP Sheila Paul, who said he was confused and unable to answer questions clearly.
November 1st: Mr Zouhri is being rushed to the John Radcliffe Hospital in Oxford in an ambulance. because the disease has reached its central nervous system, it is diagnosed with & # 39; furious & # 39; clinical rabies, which is inevitably fatal.
November 4, 2018: Omar Zouhri dies at the same hospital in Oxford, where he lost his oldest child to leukemia a few years earlier.
The investigation found that immediately after the bite the victim had taken himself and a boy, who was also bitten, to the hospital in Morocco, where he received a tetanus injection and paid for the boy to get one too.
Mr Zouhri later went to a local police station to complain about how useless the doctors had been and that they had not given him the right treatment for rabies, which is most effective when given within 24 hours of being exposed to rabies. the researcher.
The same cat had also bitten six other people within half an hour of Mr Zouhri's biting, including a young boy who later died, Mr. Salter was told.
Zouhri, born in Morocco and visiting family, returned to his home on Prebendal Avenue, Aylesbury, Bucks on September 5, the ordeal seemed behind him, but after a period of normality his health was questioned when he and his family was informed by a Moroccan doctor in early October about the boy's death
Concerned that he too might have been infected, Mr. Zouhri rushed to A&E at Stoke Mandeville Hospital a day or so later, after his wife was delivered to the number of the number in the early afternoon on October 6 in the early afternoon. South Central Ambulance Service 111 he was seen by a nurse, Menchie Mallari.
During cross-examination, Nurse Mallari admitted that she did not know when Mr. Zouhri arrived at the hospital and told her that he had been bitten by a cat about the policy of the Buckingham Healthcare NHS Trust that a person bitten by a suspicious rabid animal must reported and treated urgently, a risk assessment must be carried out and a microbiologist must be contacted.
Instead, nurse Mallari had sought the advice of a plastic surgery registrar, Dr. Marie Song, who explained to the coroner: & # 39; Plastics Treat Pet Bites. & # 39;
According to Nurse Mallari's note from a telephone conversation with Dr. Song, the registrar had told her: "Rabies can get the most from dog, not from cat."
Dr. Song, who testified at the investigation, said: & I can't remember that. Normally I would not raise rabies in a conversation about animal bites. & # 39;
Dr. However, Song had not taken note of the ad hoc advice she gave during the first day of her busy 48-hour shift in the busy department, heard the investigation, and she could not even say for certain whether she had spoken to nurse Mallari by telephone or personally.
Mr. Zouhri was shortly afterwards discharged from A&E and on the same day a letter was sent to his doctor informing him of his presence.
Coroner Mr. Salter told the research in his closing remarks: & It seems that the onset of clinical rabies symptoms was from October 28.
We have the reference to the expression & # 39; the die is rolled & # 39; heard, but it is also important to understand, the likelihood is that it must follow that the virus had already traveled from the site of the bite to Mr. Zouhri's central nervous system before October 28.
& # 39; We have evidence that there was a difference in the memory of events, which is described as a miscommunication. It seems to me that nurse Mallari can better remember the events.
Omar Zouhri, 58 (photo) of Aylesbury, was bitten by the rabid animal while on vacation with his family on 31 August last year. He died on November 4
& # 39; No risk assessment has been carried out which, if it had been carried out, would almost certainly have resulted in the recognition of Zouhri as a high risk case for which the rabies vaccine was required. The Bucks Healthcare Trust has conducted their own research and that failure is accepted.
& # 39; A related issue is: what about the delay in administering the rabies vaccine and the causal link issue – a period of about five days if you take into account the time needed to get the vaccine on and obtain it from Public Health England.
& # 39; It is very, very difficult for everyone to say at what stage the virus has reached Mr. Zouhri's central nervous system.
& # 39; It seems unlikely that a five-day delay is causal, but I can only say it seems unlikely, but it remains a possibility that if the vaccine had been given five days earlier and the virus had not spread to the central nervous system by then there might have been a different result. & # 39;
The coroner added that the real tragedy was Mr. Zouhri, who was born in Morocco, despite his efforts not being able to access proper treatment while he was in Morocco.
Dr. Stephen Gardner, president of the Department of Medicine, said that a Serious Incident Investigation conducted by the Bucks Health NHS Trust had concluded that there had been a failure and both Dr. Song like Nurse Mallari had undertaken personal reflection and learning.
In addition, Dr. Gardner stated, the rabies vaccine had since then been routinely stored at Stoke Mandeville Hospital, which was not the case when Mr. Zouhri was being treated.
Dr. Gardner said: & # 39; We see one or two patients a year who have had a bite from abroad. We've had an episode since last November and we have the vaccine in stock, so I know the process works. & # 39;
Chadia Zouhri, a housewife and the widow of Mr. Zouhri, told the investigation in a statement that her husband was already fit and well & # 39; was, but told October 30 that he was in extreme pain.
The full-time carer went to two hospitals in Morocco (the capital of Marrakech shown), but did not receive a rabies vaccine
Zouhri had participated in a general practitioner post outside office hours on October 28, complaining of pain and itching in his finger, but the investigation found that he was reassured that his symptoms were not due to rabies and was advised to try anti-itch cream.
On October 29, he contacted his doctor Dr. Rachel Moghal and said the pain was radiating from his arm & # 39; of the bite on his finger, which was completely healed, and two days later he called the doctor again to tell them randomly about muscle twitching.
With his son, mr. Zouhri again to Stoke Mandeville Hospital on October 31, where he was seen by a physician Sheila Paul, who said: “He seemed confused and unable to answer my questions clearly.
& # 39; I asked his son if he was here to translate, but he told me that his father spoke excellent English when he was healthy – this was unusual. & # 39;
Zouhri had been rushed in an ambulance to John Radcliffe Hospital in Oxford on November 1, with a paramedic from the South Central Ambulance Service in the back of the vehicle, wearing full protective equipment, the investigation heard.
Dr. Andrew Brent, the clinical leader for infectious diseases at John Radcliffe Hospital, who was part of the team to treat Mr. Zouhri, said the father had spoken on arrival at the JR and recalled previous visits to the hospital when his oldest child unfortunately died of leukemia.
Zouhri had & # 39; furious rabies & # 39; Dr. Brent explained to the study, so by the time the patient arrived at the hospital, palliative care was the only realistic option.
Dr. Brent said: & # 39; Clinical rabies is almost unique as a contagious disease because it essentially dies 100%. There is a very small number of cases in which patients have survived.
& # 39; There is no good scientific basis for treatment that would prevent death in this situation. & # 39;
However, Dr. Brent said, it is possible to save a rabies patient if they can start treatment before the virus enters their immune system.
The course of rabies treatment, the study was told, has been administered four doses of vaccination for rabies and human rabies immunoglobulin (antibodies) over a 21-day period.
Zouhri had started this course of treatment and received his first dose on October 12, Dr. Mughal the investigation.
He was identified by Public Health England as a case with a & # 39; high risk red category & # 39 ;, which doctors had reported during his local operation in Aylesbury that he was bitten by a cat in Morocco where rabies is endemic .
He did not receive his fourth and final dose, the study heard, because his rabies had already developed into a fatal clinical rabies.
It was not until November 4 that Mr Zouhri died at John Radcliffe Hospital and a pathologist. Professor Ian Roberts told the coroner that the cause of death was & # 39; rabies after a cat bite in Morocco & # 39 ;.
Roberts added that rabies symptoms only appeared after one to three months after the bite, although it may take years, but death occurs within 10 days of seeing the symptoms.
The research was told that 99 percent of human rabies is caused by a deep bite from an infected dog and the last recorded case of rabies from the UK was 1902.
Since 1946, 25 cases of rabies have been reported in the UK, all imported from abroad and, in one case, an accredited bats landlord in 2002, David McRae has contracted a special form of rabies found in several Northern European countries by a bat in Scotland.
In a narrative conclusion, Mr. Salter said: & # 39; Mr. Zouhri was on holiday on a family visit to Morocco on August 31, 2018, when he was bitten by a rabid cat.
& # 39; He initially sought treatment in the UK on October 5 and was seen at Stoke Mandeville Hospital on October 6 and started his rabies vaccine by his doctor on October 12.
& # 39; He started experiencing symptoms on October 28 and then worsened and died on November 4 at John Radcliffe Hospital for rabies following a cat bite. & # 39;
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