Category 1 Continuing Medical Education credit for WMS member physicians is available for this article. Go to http://wms.org/cme/cme.asp?whatarticle;eq1832 to access the test questions.
Rabies, a fatal encephalitis of viral origin, is still a major health problem in the developing world. It begins, after exposure, with centripetal spread of the virus through peripheral nerves to the central nervous system. The virus proliferates there and spreads to the tissues via peripheral nerves. The diagnosis is not difficult when a nonimmunized patient presents with hydrophobia after a bite by a known rabid animal. Failure to identify an exposure and administer postexposure prophylaxis, however, can lead to a fatal outcome. We report 3 fatal cases of rabies in which the risk of developing rabies had not been seriously considered. Two had apparent dog bites, but 1 had a minor abrasion. Because rabies is uniformly fatal, possible exposure should be seriously considered in patients with mammalian bites or scratches.