Acute and critical care for rabies bitten patients and the different outcomes in a Family: A Post Exposure Prophylaxis (PEP) Failure report

Rabies is a zoonotic viral disease that spread via infected animal saliva. Rabies virus belongs to Lyssavirus genus (Rhabdoviridae family) and the disease is endemic in Iran. The disease causes a fatal encephalomyelitis by infecting the nervous system. Dogs are the most common source of human rabies cases. In this presentation, we had a 58-year-old man who had a dog bitten history on his face and hands with his other two family members with the same dog at the same time. They received post-exposure prophylaxis (PEP) as soon as possible (from day 0). Eighteen days after bitten the man hospitalized and died of rabies three days after hospitalization. Other two relatives were healthy without any rabies symptom. The man was an Iranian veteran with residual body insults during the attacks of chemical warfare from the combat front. Obtained data in this study suggested that the direct inoculation of the virus to the nerve and immune system inability in virus clearing system were possible etiologies of PEP failure in the reported case. Keywords: Rabies Virus, Immunoglobulin, Pre-Exposure Prophylaxis (PrEP), Immunosuppression