The U.S. Centers for Disease Control and Prevention (CDC) confirmed this month that an American man died of rabies last year.

A 42-year-old psychiatrist from Virginia made an emergency visit to a hospital on Oct. 2, 2009, after experiencing chills and hot flashes accompanied by discomfort in his legs, urinary incontinence and back pain, according to the CDCs Morbidity and Mortality Weekly Report (MMWR).

After being sent home with a diagnosis of lumbar back pain, the man began exhibiting signs of hydrophobia at home: gagging while drinking and showering. The next day he saw his primary care physician and expressed concern that he might have rabies. He was referred back to the emergency department, and was subsequently admitted to the hospital in order to undergo tests for neurological disorders. The man revealed that he had been in India about three months prior, but did not specifically say he had any animal contact.

Within 24 hours the man’s condition deteriorated to the point where he was involuntarily shouting, choking on large amounts of his own saliva and unable to follow instructions. By his second day in the hospital, the CDC had confirmed that the man had a type of rabies common among dogs in India.

The treating physician initiated the Milwaukee protocol, an experimental treatment that involves aggressively sedating the patient into an induced coma in hopes that they will survive the brain dysfunction caused by the virus. The protocol was developed by doctors in Wisconsin and led to one of the only documented cases of a human surviving rabies after becoming symptomatic. In the Virginia case, however, the protocol failed, and by hospital day 25 the man was dead.

His was the seventh death in the United States from rabies acquired abroad since 2000.