A grandmother who died from rabies four months after being scratched by a stray puppy in Morocco was only diagnosed when doctors thought she was suffering a mental health crisis, an inquest has heard.
Company director Yvonne Ford and her family had concerns for her health in May last year when she began suffering from headaches and anxiety and her condition deteriorated further when she first attended Barnsley Hospital on June 2.
The 59-year-old’s symptoms progressed to nausea, hallucinations, severe agitation, panic attacks, difficulty eating and hydrophobia – a fear of water – which caused her to spit and left her unable to drink, Sheffield Coroners Court heard.
Doctors were struggling to diagnose what was wrong with her and believed it could have a mental health cause so she was referred to psychiatrist Dr Alexander Burns four days after she was first admitted to hospital.
Dr Burns asked about the family’s recent foreign travel history as he had concerns that she may have Lyme disease – which can be caused by tick bites.
The psychiatrist was told about a recent trip to Florida but Mrs Ford’s family confirmed she had not suffered any insect bites.
By this stage, Mrs Ford, of Barnsley, had been told she was suffering from delirium but she said she ‘felt there was more to it than that’ and asked ‘if she was developing dementia.’
However, Dr Burns was then told by Mrs Ford’s husband, Ron, that she had been scratched on the leg by a dog they had startled on a beach while on holiday in Morocco and it had pierced the skin.
Much-loved grandmother Yvonne Ford was scratched by a stray puppy while on a beach in Morocco in February last year and died four months later
Mr Ford confirmed his wife had not received a rabies vaccine prior to travelling to the North African country.
Other doctors were said to have been previously unaware of this information.
Mr Ford said the scratch was so minimal at the time that his wife treated it with a wet wipe.
Dr Burns immediately grew concerned that Mrs Ford may have contracted rabies following the dog scratch owing to her symptoms and she was swiftly referred to a specialist infectious diseases team at Royal Hallamshire Hospital in Sheffield.
Sadly her condition deteriorated further and she died on June 11.
Dr Burns said: ‘She was sat in bed, wide-eyed and perplexed and spitting into a bowl. I was concerned the diagnosis might be rabies in the context of having a stray dog bite three months ago.
‘At that stage, because my knowledge of rabies was limited, I looked into it more and was looking up more symptoms in the office and it became clear all of Yvonne’s symptoms could be explained by that diagnosis.’
The inquest also heard from Dr Katharine Cartwright, a consultant in infectious diseases at Sheffield Teaching Hospitals NHS Foundation Trust, who said that rabies ‘has the highest mortality rate of any infection in the world.’
She said rabies is 100% fatal once symptoms are present and there is no cure.
Dr Cartwright said there had only been 26 reported cases of rabies in the UK since 1946 and of 100 cases reported in the US, only half had been correctly diagnosed as rabies before death.
She said: ‘It is incredibly rare how she presented, with the combination of symptoms she had.
‘Rabies is so unusual, so out of everyone’s experience, it’s not unusual for it not to be considered within a few days and it took her deterioration and quite distant travel history to get to the dog bite.’
Mrs Ford’s husband, Ron, has been asking questions of witnesses on behalf of the family at the inquest at Sheffield Coroners Court
Mrs Ford’s daughter, Robyn Thomson, 32, is a neo-natal nurse and has called for greater awareness around rabies
Medics at the inquest referred to Mrs Ford being ‘bitten’ by the stray dog, but Mr Ford said it was a scratch.
The inquest heard that Mrs Ford also visited her GP with headaches and a complaint of reaction to an insect bite in March and April of last year. She was later diagnosed with hives.
But Dr Cartwright said these symptoms were not linked to rabies, which can take between a month to three months for symptoms to show but longer in some cases.
The inquest is being held before a jury as it relates to a death from a notifiable disease.
Mr Ford told the inquest that when his wife’s condition began deteriorating the family were ‘panicking like hell because my wife was poorly and we thought not enough was being done.’
But the inquest heard that once rabies symptoms emerged, death normally occurs within a few weeks.
The UK has been rabies-free since 1922, when the last indigenous non-fatal case was recorded, with the exception of rabies-like viruses in some wild bat species.
The last death caused by rabies in a UK animal – other than bats – was in 1902. Dog licensing, euthanasia of stray dog and quarantining were credited with killing off the virus.
Western Europe is now considered low risk for the disease by the World Health Organisation (WHO), while countries in Eastern Europe are listed as ‘moderate risk’ and African and Middle Eastern countries are ‘high risk’.
Popular tourist destinations such as Egypt, Tunisia, Morocco and Turkey all carry a high risk of dogs transmitting rabies to people.
The inquest continues.
