Do anaesthetics and surgical stress increase the risk of post-exposure rabies treatment failure?

Rabies is fatal in humans and, after exposure, only correct postexposure treatment as outlined in World Health Organization guidelines can prevent the disease. Analysis of case reports of treatment failures has shown that recommendations have not been followed and that patients presenting risk factors should receive additional care. Known risk factors are delay of more than 24 h in starting postexposure treatment, multiple wounds (especially on head, neck, arm or fingers), incorrect initial wound treatment, immunodepression and non-application of anti-rabies immunoglobulins or serum. We present a case, recently reported from India to Drug Surveillance Behringwerke AG, Marburg, Germany, in which surgery under ketamine anaesthesia might have been an additional risk factor for postexposure treatment failure.