Abstract

Rabies is a deadly zoonotic encephalomyelitis with 99% fatality rate and contributes to 59 000 global deaths annually. This disease had been successfully eliminated from Malaysia in 1999 only to re-emerged in 2017. Since then, the cumulative total human rabies cases now stood at 70 with 63 deaths. Sarawak recorded 13 deaths from 15 rabies cases in 2023. In Asia, rabid dog bites contribute to 99% of human infections. After an average incubation period of 6 to 8 weeks, the infection manifests clinically as encephalitic rabies or paralytic rabies. Encephalitic rabies, also known as furious rabies, accounts for two thirds of cases and is characterized by hyperexcitability, agitation, hydrophobia and aerophobia. Meanwhile, paralytic rabies, or dumb rabies, which accounts for the remaining one third of cases, follows a less dramatic course with ascending lower motor neuron weakness with preserved consciousness until the preterminal phase. Human rabies is 100% preventable and good health seeking behavior upon animal bite is crucial in its prevention and control. We highlight two case reports of human rabies infection with different outcomes and the role of palliative care in both cases in Sarawak, Malaysia. The first case is a young man with encephalitic rabies who succumbed to the illness rapidly. Conversely, the second case is another young man with paralytic rabies who recovered with residual weakness. Both men received palliative care during their admissions to the tertiary hospital.