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Rabies kills Monticello man bitten by bat

  • Article by: Joy Powell
  • Star Tribune
  • October 24, 2007 - 8:05 AM

Randy Hertwig of Monticello swatted at the bat that flew around the cabin porch, and he felt only a pinprick on his hand that day in mid-August. There was no blood, no puncture marks, and he didn't realize that he had been bitten.

Only as Hertwig lay dying last week did his family and physicians realize he had contracted rabies, a neurological virus that's almost always fatal once symptoms begin. Hertwig, a 46-year-old father who loved the outdoors, died Saturday at St. Marys Hospital in Rochester.

He is the fifth person to die of rabies in Minnesota in the past century. Other victims died in 1917, 1964, 1975 and 2000.

"What is most saddening about these deaths is that they could have been prevented with prompt medical attention following exposure," said Ruth Lynfield, state epidemiologist and medical director for infectious diseases at the Minnesota Department of Health.

Each year, two to three people contract rabies in the United States, down from more than 100 each year in the early 1900s, according to the state Health Department.

Bats cause nearly all of the human rabies cases in this country.

Entries by Hertwig's wife, Michele, and son and daughter on the CaringBridge.org website chronicle the way Hertwig's symptoms began a month after the bite went unnoticed as he stacked firewood on a porch.

Four weeks later, in mid-September, a tingling began in his hand where he had been bitten. Soon Hertwig lost his ability to talk or even move, and by mid-October, the longtime machinist lay in a deep coma, beyond reach of even the best medicine.

It's a heartbreaking case, but also, Minnesota health officials said Tuesday, an opportunity to educate the public on how easily a person can contract rabies from a bat or wild animal. The tiny teeth of a bat can scratch or bite without a person even noticing.

"That is one of the big problems with bats, that you can be bitten and not know it," said Joni Sheftel, a state veterinarian for the Minnesota Department of Health. "You can be bitten in your sleep. You can actually have a bat brush up against you and be bitten and not realize that you are bitten."

Experts at the Minnesota Department of Health test brain samples of bats and other animals for rabies. If rabies are detected, anyone who has had contact should have vaccinations immediately. The disease can incubate in a matter of days, or even years.

Sheftel declined to provide any specifics of Hertwig's death because of medical privacy statutes but she did talk in general terms about the frequency of rabies, how to avoid being bitten, and what to do if you may have had a scratch or bite.

"We have some special rules for bats," said Sheftel, who specializes in zoonotic diseases. "The biggest one is that if you wake up and there's a bat in your room, we want you to catch the bat and we will test it for rabies. There's no charge for testing at the state."

The person trying to catch the bat should use thick gloves and a hard container. Bats can bite through sacks and pillowclothes.

"If the bat escapes, or you inadvertently let it out," she said, "then we consider that an exposure and we would recommend rabies [treatment] post-exposure."

People who may have been exposed to the rabies virus can get an injection of rabies immune globulin and five doses of rabies vaccine over a one-month period.

Sheftel said it's important not only to avoid bats or wild animals that might have rabies, but also to immunize pets.

Victim loved the outdoors

Randy Hertwig was born and reared in the Alexandria area north-central Minnesota. At 22, he married Michele Ward. He began working a few years later as a machinist for Buhler of Plymouth, where he would work for the next 20 years. In his spare time, Hertwig loved to be outdoors with his son, Jess, and daughter, Summer. They boated, snowmobiled, hunted and romped with the dogs, Aly and Gracie.

The week of Sept. 17, according to the family's entries on the CaringBridge website, Randy Hertwig put off going to the doctor about the odd feeling in his thumb and index finger. Throughout the week, the feeling spread into his hand. By Thursday, he couldn't lift his arm.

There were trips to the doctors in Monticello and tests, and then, on Saturday morning, Hertwig landed in a St. Cloud emergency room, his heart pounding more than 120 beats a minute.

Magnetic Resonance Imaging (MRI) pictures showed his spinal cord inflamed. Physicians wondered if it could be a virus, or maybe multiple sclerosis. Hertwig had shooting pains in his arm, his face was turning numb and his balance was off, so walking was tough. Soon, so was talking.

By Oct. 3, it was hard for Hertwig to get up, and he barely moved his legs. The little movement he had in his left hand was gone, Summer Hertwig wrote on the website. Three days later, and the doctors had placed a feeding tube in him. A ventilator helped him breathe.

The doctors continued to run test after test, They exchanged plasma in his blood to help with clotting. Nurses kept checking his dilated pupils for a sluggish response, but didn't always get one. Last Tuesday, one more in a series of MRIs came back with worrisome findings.

The doctor "asked if Randy had been bitten by a bat recently," Michele wrote on CaringBridge.org. "In August, Randy did grab a bat out of a cabin but said that he didn't think it broke through his skin. The doctors were going to do a skin biospy and another lumbar puncture."

His family learned that there was no cure for the deadly virus, once symptoms start. It interferes with the communications channels in the brain, and progresses quickly to coma and death.

The rabies diagnosis was confirmed on Thursday.

Summer Hertwig later wrote that at 12:01 a.m Saturday, "We let God take Dad."

Though he couldn't talk, and the doctors said he was in a coma, his family believes that Randy Hertwig sent a final message. Summer wrote:

"Everyone was in the room, and Dad gave us one more sign that he loved us and that he was going to miss us just as much as he did. Most of us saw it, and couldn't believe it. He shed a tear, out of his left eye."

Investigation underway

The state Health Department is working with health care facilities where Hertwig was given care to evaluate whether any workers may have been exposed to his saliva and need treatment to prevent a rabies infection, officials said Tuesday.

Sheftel said she hopes that people who learn that a man has died of the disease will heed the warning. "Bats are found all over the state of Minnesota," she said. "It doesn't at all matter what county this particular cabin was in."

Last year, she said, the state tested 482 bat brains and found 16 had rabies. That's 3.3 percent. So far this year, the state has tested 406 bats, with 13 positive for rabies.

The treatment for rabies, if administered early, is nearly 100 percent effective, Sheftel said. The incubation for human rabies can range tremendously from person to person, from seven days to seven years, but it's typically four to 12 weeks, she said

"We really want to get this message out," Sheftel said. "Once symptoms start, it's too late."

On Tuesday night, a visitation for Randy Hertwig was held in Monticello.

Services will be at 11 a.m. Wednesday at Hosanna Lutheran Church of Buffalo, with visitation one hour before the funeral.

Joy Powell • 612-673-7750

Joy Powell • jpowell@startribune.com

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