Ptosis as a presenting feature of bacterial meningitis.

To the Editors: Willoughby and Hammarin have recently discussed human rabies caused by bat rabies virus variants. They stated “the colonial species of bats found in very large numbers under bridges and in caves in central Texas have not transmitted rabies to humans.” The main bat species they are referring to is the Brazilian (Mexican) free-tailed bat, Tadarida brasiliensis, and the rabies virus variant associated with this species is actually second only to the variant associated with Lasionycteris noctivagans (silver-haired bat) and Pipistrellus subflavus (eastern pipistrelle bat) as the most common cause of human rabies in the United States. Since 1990, there have been 7 well-documented fatal cases of human rabies resulting from infection with this variant in Texas (1990), Alabama (1994), California (1995, 2000 and 2002), Georgia (2000) and Arkansas (2004). The latter case was an organ donor in Texas, and transmission occurred to 4 transplant recipients with fatal outcomes. Although rabies is very common in big brown bats (Eptesicus fuscus), the variant associated with these bats is a rare cause of fatal human rabies, and a case occurred in Washington in 1997. Little brown bats (Myotis lucifugus) belong to the Myotis species, and variants associated with this genus have also caused fatal human rabies in Washington in 1995 and in British Columbia in 2003. Alan C. Jackson, MD Departments of Medicine (Neurology) and Microbiology and Immunology Queen’s University Kingston, Ontario, Canada