Abstract

Rabies is an acute viral infection of the central nervous system. It is transmitted to humans through an infected animal’s bite and almost always results in death. There is no effective medical treatment for rabies; therefore, precaution against the disease is vitally important. Herein, two cases of human rabies followed within a month are reported. In the first case, a 42-year-old Syrian man was admitted to emergency service with high fever, general weakness, hypersalivation and dysphagia and a history of a dog bite about 45 days ago in Syria. In the second case, a-36-year-old Syrian man was admitted to another border city hospital with high fever, hydrofobia, photophobia and hypersalivation and a history of a dog bite about 3 months ago in Syria. Shortly after admission, both patients' neurological status severely deteriorated. With the development of progressive respiratory failure, they required ventilator support and strong sedation with a presumptive diagnosis of rabies. The saliva sample and nuchal skin biopsy of the first case were positive for rabies virus with the antigen being revealed by direct fluorescent antibody test. The results were also positive for rabies virus by reverse transcriptase polymerase chain reaction. Thus, the diagnosis was confirmed on the fourth day of the admission, and on the 19th day, he was deceased from rabies encephalitis. The second case died on the second day of his admission, and his brain biopsy was positive for rabies virus antigen. These cases emphasize the importance of dog bites in rabies transmission and underscores the need for public education for rabies prevention.