Edit concept Question Editor Create issue ticket

Rabies

Hydrophobia

Rabies is a viral infection caused by lyssaviruses.


Presentation

Rabies presents itself in the form of flu like symptoms in the beginning. The incubation period is around 2-12 weeks. Later the symptoms seen are increased sensation at the site of bite, excitability, muscle spasms, restlessness, excitability, slight or partial paralysis, pain at the site of bite, numbness and tingling, convulsions, insomnia, agitation, low-grade fever, confusion, paranoia, hallucinations, terror, abnormal behaviour that progresses towards delirium.

Drooling is also seen as the saliva production is highly increased. Any attempt to drink or even the intention of drinking can lead to very painful spasms of the muscles in throat and larynx. Death is the final outcome in 2-10 days, once the symptoms start showing. The chances of survival are negligible even if proper intensive care is given [10].

Fever
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • The previous evening, a Puerto Rican man aged 54 years arrived at the emergency department with fever, difficulty swallowing, hand paresthesia, cough, and chest tightness.[ncbi.nlm.nih.gov]
  • These early symptoms can include: Fever Headache General tiredness Discomfort, numbness, or pain at the site of the bite.[rabies.emedtv.com]
  • The next day, he had rhabdomyolysis, fever, and rigidity, and neuroleptic malignant syndrome was diagnosed.[ncbi.nlm.nih.gov]
Animal Bite
  • Overall, 81.2% of animal bite victims treated their wounds improperly after suspected rabies exposure, and 35.3% of animal bite victims delayed the initiation of PEP.[ncbi.nlm.nih.gov]
  • Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized.[ncbi.nlm.nih.gov]
  • Data on animal bite incidence from the study cohort were compared to that obtained from a review of consultation records at the Animal Bite Treatment Center (ABTC).[ncbi.nlm.nih.gov]
  • Conclusions: Although all animal bite victims received complete PEP, in some cases, there were delays.[ncbi.nlm.nih.gov]
  • RELEVANT CHANGES: Over a 9-month period, 12 121 animal bites were reported to clinics and entered in the registry.[ncbi.nlm.nih.gov]
Veterinarian
  • Both veterinarians and students regarded bats and horses as high-risk species for zoonoses. CONCLUSIONS: Queensland veterinarians and veterinary students have low levels of protection against ABLV.[ncbi.nlm.nih.gov]
  • We report an antemortem and postmortem diagnosis of rabies in a veterinarian who became infected when handling herbivores with rabies.[ncbi.nlm.nih.gov]
  • In the multivariable model, age, presence of a collar, region, sex, use and having ever visited a veterinarian were significantly associated with rabies vaccination.[ncbi.nlm.nih.gov]
  • If possible, the animal that bit patient should be captured and delivered to a veterinarian for investigation of rabies.[symptoma.com]
  • The offspring of wild animals crossbred to domestic dogs and cats (wild animal hybrids) are considered wild animals by the National Association of State and Public Health Veterinarians (NASPHV) and the Council of State and Territorial Epidemiologists.[web.archive.org]
Malaise
  • On July 8, 2012, a U.S. resident was admitted to a hospital in Dubai, United Arab Emirates, for evaluation of right arm spasticity, anxiety, and malaise. By the next day, the patient had become comatose following a period of agitation.[ncbi.nlm.nih.gov]
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • […] to three months, but may range from one week to one year. (1) The first signs of the disease include pain or an abnormal sensation at or around the wound, followed by other non-specific symptoms such as fever, anorexia, nausea, vomiting, headaches, malaise[sanofipasteur.com]
  • The illness begins with a non-specific prodrome period, comprising of fever, malaise, anorexia, N V, sore throat, myalgia and headache. The patient nay exhibit irritability and abnormal sensations around the wound.[web.archive.org]
Chills
  • On December 3, 2011, a South Carolina woman visited a local emergency department (ED) with an overnight history of shortness of breath, diaphoresis, chills, and intermittent paresthesia.[ncbi.nlm.nih.gov]
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • The initial symptoms may be a general feeling of discomfort or uneasiness, nervousness, anxiety, insomnia, depression, loss of appetite, fever, chills, cough, sore throat, headache, nausea, vomiting, and pain at the site of exposure.[rarediseases.org]
  • They include: a high temperature of 38ºC (100.4ºF) or above chills fatigue (extreme tiredness) problems sleeping lack of appetite headache irritability anxiety sore throat vomiting Around half of people will also experience pain and a tingling sensation[web.archive.org]
  • Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess.[nytimes.com]
Pharyngitis
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • Patient starts developing nonspecific signs and symptoms like paresthesia, pain or severe itching at the site of injury, fever, insomnia, malaise, depression, agitation, headaches, pharyngitis etc.[symptoma.com]
  • The following day, the patient developed severe tremor and myoclonus of the face and all extremities, priapism, drooling, pharyngeal spasm, and a feeling of suffocation.[ncbi.nlm.nih.gov]
  • He received a diagnosis of pharyngitis and was prescribed amoxicillin; the vaccinations were deferred. That evening, the boy was taken to a hospital emergency department (ED) with chest tightness, dysphagia, and insomnia.[cdc.gov]
Pharyngeal Spasm
  • The following day, the patient developed severe tremor and myoclonus of the face and all extremities, priapism, drooling, pharyngeal spasm, and a feeling of suffocation.[ncbi.nlm.nih.gov]
Aspiration
  • As the neurologic phase of rabies advances, chest radiographs might reveal infiltrates due to aspiration, acute respiratory distress syndrome, nosocomial pneumonia, or congestive heart failure.[symptoma.com]
Vomiting
  • Army soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety, and dysphagia was admitted to an emergency department (ED) in New York for suspected rabies.[ncbi.nlm.nih.gov]
  • Dogs: aggression, howling, attacking without warning, salivation, biting at imaginary flies, fixed stare, wandering aimlessly, dropped lower jaw, inabililty to swallow, eating soil and sticks, choking, vomiting, difficulty in walking, paralysis Cats:[web.archive.org]
  • The initial symptoms may be a general feeling of discomfort or uneasiness, nervousness, anxiety, insomnia, depression, loss of appetite, fever, chills, cough, sore throat, headache, nausea, vomiting, and pain at the site of exposure.[rarediseases.org]
  • […] incubation period is one to three months, but may range from one week to one year. (1) The first signs of the disease include pain or an abnormal sensation at or around the wound, followed by other non-specific symptoms such as fever, anorexia, nausea, vomiting[sanofipasteur.com]
  • Later signs and symptoms may include: Fever Headache Nausea Vomiting Agitation Anxiety Confusion Hyperactivity Difficulty swallowing Excessive salivation Fear of water (hydrophobia) because of the difficulty in swallowing Hallucinations Insomnia Partial[mayoclinic.org]
Nausea
  • Army soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety, and dysphagia was admitted to an emergency department (ED) in New York for suspected rabies.[ncbi.nlm.nih.gov]
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • The initial symptoms may be a general feeling of discomfort or uneasiness, nervousness, anxiety, insomnia, depression, loss of appetite, fever, chills, cough, sore throat, headache, nausea, vomiting, and pain at the site of exposure.[rarediseases.org]
  • […] mean incubation period is one to three months, but may range from one week to one year. (1) The first signs of the disease include pain or an abnormal sensation at or around the wound, followed by other non-specific symptoms such as fever, anorexia, nausea[sanofipasteur.com]
  • Later signs and symptoms may include: Fever Headache Nausea Vomiting Agitation Anxiety Confusion Hyperactivity Difficulty swallowing Excessive salivation Fear of water (hydrophobia) because of the difficulty in swallowing Hallucinations Insomnia Partial[mayoclinic.org]
Diarrhea
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
Drooling
  • The Salivary glands are concentrated with the virus in the infected animal and cause excessive drooling. This is the primary way the virus transmits itself.[web.archive.org]
  • Other symptoms may include: Drooling Seizures Bite site is very sensitive Mood changes Nausea and vomiting Loss of feeling in an area of the body Loss of muscle function Low-grade fever (102 F or 38.8 C, or lower) with headache Muscle spasms Numbness[nlm.nih.gov]
  • Drooling is also seen as the saliva production is highly increased. Any attempt to drink or even the intention of drinking can lead to very painful spasms of the muscles in throat and larynx.[symptoma.com]
  • At that point, a person can show symptoms like confusion, abnormal behavior, hallucinations, insomnia, drooling, difficulty swallowing and hydrophobia, fear of water. Most people die within one to two weeks of these late symptoms.[edition.cnn.com]
  • Scratches from an infected animal may cause infection because saliva is sometimes present on claws - particularly if the disease is causing the animal to drool excessively (hyper-salivation).[web.archive.org]
Hypersalivation
  • We report a case of a 6-year-old boy who presented febrile seizure with agitation and cerebellar signs, without hydrophobia or hypersalivation, 17 days after a dog bite. Despite four doses of rabies vaccine and immunoglobulin, he died.[ncbi.nlm.nih.gov]
  • Progressive Rabies Symptoms As the disease progresses, neurological symptoms appear and may include: Insomnia Anxiety Confusion Slight or partial paralysis Excitation Hallucinations Agitation Hypersalivation Difficulty swallowing Hydrophobia (fear of[rabies.emedtv.com]
  • As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear[cdc.gov]
  • On the second day of hospitalization, the patient experienced episodes of lethargy, somnolence, generalized skin flushing (associated with vancomycin administration), and hypersalivation.[cdc.gov]
  • As the disease progresses, the symptoms may progress to include: Excessive Drooling (Hypersalivation) Convulsions and violent movements Heightened sensation at the site of bite Uncontrolled Excitability and heightened response to sensations Fever Loss[web.archive.org]
Foaming at the Mouth
  • […] at the mouth the dropping of the lower jaw (in dogs) paralysis of the jaw, mouth and throat muscles[web.archive.org]
  • You might have an image in your head of a dog or raccoon acting aggressively and foaming at the mouth. But it’s not so easy to tell if you’re looking at a rabid animal. Most wild animals that have rabies actually act shy or timid.[webmd.com]
Tachycardia
  • He had tachycardia (128 beats/min) and hypertension (148/99 mmHg) but no fever; his respiratory rate and oxygen saturation level were normal.[cdc.gov]
  • The sympathetic storm management included the use of intravenous labetalol for tachycardia and hypertension.[doi.org]
Pruritus
  • The frequency of minor adverse reactions (local pain, erythema, swelling and pruritus) varies widely from one report to another.[web.archive.org]
  • The subsequent night was complicated by an intense pruritus over the scalp, neck and torso, with minimal response to diphenhydramine.[ncbi.nlm.nih.gov]
  • Approximately 6% of people receiving booster vaccinations with HDCV may experience systemic hypersensitivity reactions characterized by urticaria, pruritus, and malaise. The likelihood of these reactions may be less with PCEC.[wwwnc.cdc.gov]
Skin Lesion
  • A biopsy confirmed that the skin lesions were compatible with erythema multiforme, but no coronary aneurysm was found at autopsy.[ncbi.nlm.nih.gov]
  • Sarcoidosis is a multisystem inflammatory disorder of unknown cause manifested by enlarged lymph nodes, lung inflammation, various skin lesions, liver and other organ involvement.[web.archive.org]
Photophobia
  • There will also be fear of bright light (photophobia) and fear of breezes (aerophobia). A few days after these symptoms develop, the affected person will fall into a coma and die, usually as a result of heart or lung failure.[web.archive.org]
  • […] and difficulty breathing hypersalivation or producing a lot of saliva, and possibly frothing at the mouth fear of water, or hydrophobia, due to difficulty swallowing hallucinations, nightmares, and insomnia priapism, or permanent erection, in males photophobia[medicalnewstoday.com]
  • Accompanying features, which may include nuchal rigidity, photophobia, fasciculations, cerebellar signs, cranial nerve palsies, dysphasia, hypertonia or hypotonia, extensor plantar responses and convulsions.[patient.info]
  • […] to the pain resulting from other ulcers), nightmare, aggression and agitation, confusion and loss of thinking ability, talking to self, thirst, fear of crowded places (corresponding to agoraphobia in current terminology), fear of light (equivalent to photophobia[doi.org]
Myalgia
  • The illness begins with a non-specific prodrome period, comprising of fever, malaise, anorexia, N V, sore throat, myalgia and headache. The patient nay exhibit irritability and abnormal sensations around the wound.[web.archive.org]
  • ., fever, asthenia and myalgia), and local injection-site-related reactions (e.g., redness, swelling and pain).[doi.org]
Muscle Twitch
  • Acute neurologic period Neurologic symptoms develop, including: confusion and aggression partial paralysis, involuntary muscle twitching, and rigid neck muscles convulsions hyperventilation and difficulty breathing hypersalivation or producing a lot of[medicalnewstoday.com]
Right Shoulder Pain
  • Abstract In late December 2010, a male resident of Wisconsin, aged 70 years, sought treatment for progressive right shoulder pain, tremors, abnormal behavior, and dysphagia at an emergency department (ED).[ncbi.nlm.nih.gov]
Delusion
  • During these episodes a person may have some or all of the following signs and symptoms: aggressive behaviour, such as thrashing out or biting agitation hallucinations – seeing or hearing things that are not real delusions – believing things that are[web.archive.org]
  • Psychiatrist Kumar Kanti Ghosh, who has researched PPS for almost two decades and helped document the phenomenon for an article in the medical journal Lancet in 2003, said a mass hysteria or group delusion was behind the superstitious belief of puppy[web.archive.org]
Headache
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • These early symptoms can include: Fever Headache General tiredness Discomfort, numbness, or pain at the site of the bite.[rabies.emedtv.com]
  • The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort.[cdc.gov]
  • There may not be any symptoms for weeks or even years after the bite, but rabies can cause pain, fatigue, headache, fever and irritability. If untreated, symptoms can progress to confusion, hallucinations, insomnia, seizures and paralysis.[walgreens.com]
Agitation
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • We report a case of a 6-year-old boy who presented febrile seizure with agitation and cerebellar signs, without hydrophobia or hypersalivation, 17 days after a dog bite. Despite four doses of rabies vaccine and immunoglobulin, he died.[ncbi.nlm.nih.gov]
  • Progressive Rabies Symptoms As the disease progresses, neurological symptoms appear and may include: Insomnia Anxiety Confusion Slight or partial paralysis Excitation Hallucinations Agitation Hypersalivation Difficulty swallowing Hydrophobia (fear of[rabies.emedtv.com]
  • She initially presented to a local hospital with agitation and over talkativeness and was diagnosed as having an acute psychotic state.[ncbi.nlm.nih.gov]
  • By the next day, the patient had become comatose following a period of agitation. On July 31, he died.[ncbi.nlm.nih.gov]
Confusion
  • Progressive Rabies Symptoms As the disease progresses, neurological symptoms appear and may include: Insomnia Anxiety Confusion Slight or partial paralysis Excitation Hallucinations Agitation Hypersalivation Difficulty swallowing Hydrophobia (fear of[rabies.emedtv.com]
  • A 58-year-old British Asian woman was referred to a regional general hospital in the UK with hydrophobia, anxiety and confusion nine weeks after receiving a dog bite in North West India.[ncbi.nlm.nih.gov]
  • In the first case, patients show agitation, hyperactivity, restlessness, trashing, biting, confusion or hallucinations. Hydrophobia and aerophobia are pathognomonic for rabies and occur in 50% of patients.[orpha.net]
  • As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear[cdc.gov]
  • This syndrome is characterized by paralysis that starts at the bottom of a limb and moves upward (especially in the extremity that has been bitten), increased blood pressure, rapid heart rate, confusion, hallucinations and disorientation.[rarediseases.org]
Hyperactivity
  • During this time the patient may have increased periods of hyperactivity, stiffness in the back of the neck, and an abnormal increase in the number of cells in the cerebrospinal fluid ending with the onset of coma or respiratory failure.[rarediseases.org]
  • Child had dog-bite at the wrist, and developed hyperactivity, hydrophobia and hyperventilation 2 months post bite. He was hospitalised and died from respiratory failure day 3 after admission.[ncbi.nlm.nih.gov]
  • In the first case, patients show agitation, hyperactivity, restlessness, trashing, biting, confusion or hallucinations. Hydrophobia and aerophobia are pathognomonic for rabies and occur in 50% of patients.[orpha.net]
  • Patients display signs such as hyperactivity and death occurs within days due to respiratory arrest. "Paralytic" rabies accounts for around 30% of cases. It develops less rapidly.[bbc.co.uk]
  • Later signs and symptoms may include: Fever Headache Nausea Vomiting Agitation Anxiety Confusion Hyperactivity Difficulty swallowing Excessive salivation Fear of water (hydrophobia) because of the difficulty in swallowing Hallucinations Insomnia Partial[mayoclinic.org]
Insomnia
  • Progressive Rabies Symptoms As the disease progresses, neurological symptoms appear and may include: Insomnia Anxiety Confusion Slight or partial paralysis Excitation Hallucinations Agitation Hypersalivation Difficulty swallowing Hydrophobia (fear of[rabies.emedtv.com]
  • Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression.[orpha.net]
  • Patient starts developing nonspecific signs and symptoms like paresthesia, pain or severe itching at the site of injury, fever, insomnia, malaise, depression, agitation, headaches, pharyngitis etc.[symptoma.com]
  • As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear[cdc.gov]
  • The initial symptoms may be a general feeling of discomfort or uneasiness, nervousness, anxiety, insomnia, depression, loss of appetite, fever, chills, cough, sore throat, headache, nausea, vomiting, and pain at the site of exposure.[rarediseases.org]

Workup

If possible, the animal that bit patient should be captured and delivered to a veterinarian for investigation of rabies [11]. Skin biopsy from the nape of neck can be done to detect rabies antigen by direct fluorescent antibody, even corneal epithelia can be used for this purpose. Nuchal skin biopsy is a very reliable test for rabies infection in the first week.

The diagnosis can also be made using saliva, cerebrospinal fluid and brain tissue for viral cultures and polymerase chain reaction (PCR) assay but brain tissue can be obtained on postmortem and is the most reliable finding. Detection of viral RNA from saliva using PCR assay and viral antigen from brain biopsy specimens yields 100% specificity.

Blood examination may show elevated WBCs with 6-8% atypical monocytes.

As the neurologic phase of rabies advances, chest radiographs might reveal infiltrates due to aspiration, acute respiratory distress syndrome, nosocomial pneumonia, or congestive heart failure.

Electroencephalography (EEG) findings include encephalopathic changes.

The nucleic acid sequence ̶based amplification (NASBA) technique on saliva and CSF can be used for rapid diagnosis as early as 2 days after symptom onset. Serum rapid fluorescent focus inhibition test (RFFIT) titer results are positive in 50% of rabies cases.

Treatment

Clean the wound thoroughly with soap and water, and explore it carefully to remove any foreign body if present. Usually stitches are not taken so as to allow the drainage of wound fluids, avoid infection and heal the wound by secondary intention [12] [13]. Prophylactic treatment using antibiotics should be considered [13] [14].

It is recommended that any person who is not vaccinated previously against rabies should receive one dose of human rabies immunoglobulin (HRIG) followed by rabies vaccine. The dose for HRIG is 20 IU/kg for both adults and children. Give maximum dose at the site of injury and the remaining should be given as deep intramuscular injection away from the site of injury. HRIG can be given up to 7 days after the exposure to the virus, if it is not available immediately [4] [12]. Post-exposure prophylaxis dose of vaccine is 1 ml intramuscular in the deltoid or in the upper outer thigh in infants.

The first dose of rabies vaccine is given as soon as possible after exposure, and later on the other doses are given on the 3, 7 and 14 day after the first. In case of an immunocompromised patient an additional dose is given on the 28 day after the first. Patients who have taken pre-exposure vaccination previously do not need the immunoglobulin, only the post exposure vaccinations on days 0 and 2.

Intramuscular vaccination should be given into the deltoid, and not gluteal area, as it is associated with vaccination failure due to injection into fat rather than muscle.

Once the patient starts developing the symptoms of rabies, they have to be transferred to an intensive cardiopulmonary supportive care for treatment. Rabies vaccination or giving HRIG at this point is of no use. Even if the patient is given treatment, the symptoms of rabies are almost invariably fatal.

Combination treatments consisting ribavirin, interferon, ketamine, and immunomodulatory therapies has been proposed and may be considered in future cases under investigational protocols.

Prognosis

Rabies can be prevented if vaccine is given immediately after the bite. Post exposure prophylaxis (PEP) is very successful in preventing the disease if given promptly i.e. within 6 days of infection. If the vaccine is not given then the infection becomes fatal once the person starts showing neurological symptoms.

Death from respiratory failure occurs within 7 days once the symptoms start. There have been only a very few cases of survival from a rabies infection in the world till date.

Etiology

Rabies is caused due to lyssa virus family including rabies virus and Australian bat virus. The rabies virus spreads through the saliva of the infected animals to another animal or a person by the means of biting. In very few cases, rabies has spread when the infected saliva gets into an open wound or the mucous membranes. This happens if an infected animal licks an open cut on the skin.

In rare cases, human to human transmission has also taken place due to organ transplant from an infected donor. It has occurred with corneal and other organ transplants [1] [2] [3]. Animals that can transmit rabies are cows, ferrets goats, horses, beavers, cats and dogs [4] [5] [6], coyotes, foxes, monkeys, raccoons [7], skunks, woodchucks and bats [8].

Epidemiology

Rabies causes around 26,000 to 55,000 deaths across the world per year [9] and more than 95% of them occur in Asia and Africa. In biggest part of Europe and Australia it is seen only in bats. Lot of small island nations are free from rabies entirely.

Sex distribution
Age distribution

Pathophysiology

Rabies develops in the following pattern:

Incubation period: The infected person remains asymptomatic in this period. The average duration of incubation is 20-90 days. Due to a prolonged incubation period, patients do not remember the exact incident of exposure. The rabies virus is separated from the immune system during this time, and no antibody response is seen.

Prodromal period: In the period of 2-10 days, the virus enters the central nervous system (CNS). Patient starts developing nonspecific signs and symptoms like paresthesia, pain or severe itching at the site of injury, fever, insomnia, malaise, depression, agitation, headaches, pharyngitis etc.

Acute neurologic period: The patient develops objective signs of CNS disease during this period of 2-7 days. Symptoms include muscle fasciculations, focal or generalized convulsions and priapism. Sometimes patients die immediately or can progress towards paralysis, which presents only in the bitten limb at first but later becomes diffuse.

Coma: It begins within 10 days of onset, and the time period varies. In absence of intensive supportive care immediately, respiratory depression, respiratory arrest, and death follow soon after coma.

Prevention

Rabies can be prevented by decreasing the chances of coming in contact with a rabid animal. 

  • Vaccinate your pets like cats, dogs against rabies by taking advice of a veterinarian.
  • Prevent close contact with animals you don’t know.
  • Get yourself vaccinated if your work in a high-risk surrounding or if you are travelling to countries with high rate of rabies.
  • Report to your local law enforcement about any stray dogs or cats in your area.
  • Prior to transplantation screening of donors for potential rabies infection or exposure should be performed [4] so as to prevent transmission caused due to organ transplant [3].

Also getting the treatment as soon as possible following the exposure will help in preventing rabies.

Summary

Rabies is a lethal viral infection that causes inflammation of the brain in humans and is almost fatal once the person starts showing the signs and symptoms of rabies. The time span between contracting the disease and beginning of the symptoms is generally one to three months, but it can vary from few days to a year.

Patient Information

Rabies is a viral infection that is mainly transmitted from animals to the human beings. The common mode of transmission is being bitten by the animal suffering from rabies. Hence it is always advisable to get your pets vaccinated regularly and also you get yourself vaccinated to prevent it if you are in close contact of animals.

Once the symptoms of rabies start developing it is almost impossible to cure it, the patient finally succumbs to death after few days. Therefore it is suggested that whenever in case you are bitten by any stray animal better get vaccinated for rabies because their is no point of taking chances and also finding that whether that particular animal is suffering from rabies or no is difficult. Prevention is better than cure is the most apt motto in case of rabies.

References

Article

  1. Centers for Disease Control and Prevention (CDC). Investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004. MMWR Morb Mortal Wkly Rep. 2004 Jul 9;53(26):586-9.
  2. Srinivasan A, Burton EC, Kuehnert MJ, et al. Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med. 2005 Mar 17;352(11):1103-11.
  3. Jackson AC. Screening of organ and tissue donors for rabies. Lancet. 2004 Dec 11-17;364(9451):2094-5.
  4. National Association of State Public Health Veterinarians Inc. (NASPHV); AVMA; CDC; NACA. Compendium of animal rabies prevention and control, 2004: National Association of State Public Health Veterinarians, Inc. (NASPHV). MMWR Recomm Rep. 2004 Jun 25;53(RR-9):1-8.
  5. Moore DA, Sischo WM, Hunter A, Miles T. Animal bite epidemiology and surveillance for rabies postexposure prophylaxis. J Am Vet Med Assoc. 2000 Jul 15;217(2):190-4.
  6. Doyle TJ, Bryan RT. Infectious disease morbidity in the US region bordering Mexico, 1990-1998. J Infect Dis. 2000 Nov;182(5):1503-10.
  7. McLean RG. Rabies in raccoons in the Southeastern United States. J Infect Dis. 1971 Jun;123(6):680-1.
  8. Messenger SL, Smith JS, Rupprecht CE. Emerging epidemiology of bat-associated cryptic cases of rabies in humans in the United States. Clin Infect Dis. 2002 Sep 15 ;35(6):738-47.
  9. Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, et al. Human rabies: neuropathogenesis, diagnosis, and management. Lancet Neurol. 2013 May; 12 (5): 498–513.
  10. Rupprecht CE, Willoughby R, Slate D. Current and future trends in the prevention, treatment and control of rabies. Expert Rev Anti Infect Ther. 2006 Dec; 4 (6): 1021–1038.
  11. Baer GM. 1991.The Natural History of Rabies. 2n Ed. Boston, MA: CRC Press. Massachusetts, pp 620.
  12. Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008 May 23;57:1-28.
  13. Goldstein EJ. Current concepts on animal bites: bacteriology and therapy. Curr Clin Top Infect Dis. 1999;19:99-111.
  14. Rupprecht CE, Gibbons RV. Clinical practice. Prophylaxis against rabies. N Engl J Med. 2004 Dec 16;351(25):2626-35.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:54