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]

  These early symptoms can include: Fever Headache General tiredness Discomfort, numbness, or pain at the site of the bite. [rabies.emedtv.com]

  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]

  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]

• 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]

  RABIES: ISDH Guidelines for Animal Submission ISDH Protocol for Bat Euthanasia ISDH Rabies Testing Policy 3 Additional Rabies Information Animal Bites: What DVMs and Clinics Need to Know (Webinar slides February 2019) Animal Bites: What DVMs and Clinics [in.gov]

• Veterinarian

  Dee Jones, Alabama Public Health Veterinarian states that veterinarians may use rabies vaccine “in accordance to its label” in a letter written to state vets. [dogsnaturallymagazine.com]

  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]

  Have your veterinarian vaccinate all of your dogs, cats, ferrets and horses against rabies, and make sure you follow your veterinarian's instructions for revaccination. Avoid contact with wild or stray animals. [floridahealth.gov]

  If it is safe to do so, cage or otherwise subdue your dog, and take her to a veterinarian to be quarantined. [petmd.com]

• 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]

  During this stage, the individual may have a headache, fever, decreased appetite, vomiting, and general malaise. Pain, itching, and tingling may be experienced at the wound site. [orthoinfo.aaos.org]

  […] 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]

  In humans, early symptoms may include numbness around the bite, fever, headache and general malaise. Later symptoms may include muscle spasms and hydrophobia (fear of water). In an adult, the average incubation period is three to eight weeks. [simcoemuskokahealth.org]

• Fatigue

  In people, symptoms of rabies include fever, headache and fatigue, then confusion, hallucinations and paralysis. Once the symptoms begin, the disease is usually fatal. A series of shots can prevent rabies in people exposed to the virus. [medlineplus.gov]

  Fatigue. Headaches. Fever. Muscle spasms. Irritability. Excessive movements. Agitation, aggressiveness. Confusion. Seizures. Bizarre or abnormal thoughts. Hallucinations. Weakness, paralysis. Increased production of saliva or tears. [my.clevelandclinic.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]

  Early symptoms are often vague, but can include: Fever Headache Sore throat Fatigue Loss of appetite Nausea and vomiting Tingling and intense itchiness at the site of the bite after the wound has healed Anxiety and difficulty sleeping As the virus progresses [health24.com]

  […] ra·bies | \ ˈrā-bēz \ Medical Definition of rabies : an acute virus disease of the central nervous system of warm-blooded animals that is transmitted in infected saliva usually through the bite of a rabid animal and that is typically characterized by fatigue [merriam-webster.com]

• Pharyngitis

  Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression. [orpha.net]

  Horses: Early clinical signs of infection include muzzle tremors, pharyngeal (relating to the throat) paralysis, anorexia, depression, colic, and ataxia (lack of muscle control and often associated hind-end weekness). [njaes.rutgers.edu]

  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]

  In the encephalitic form of rabies the acute neurological syndrome classically includes painful pharyngeal spasms after exposure to a gust of air (aerophobia) or a drink of water (hydrophobia). [infectiousdiseaseadvisor.com]

• 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]

  A 32-year-old woman with pharyngeal spasms and paresthesias after a dog bite, N Engl J Med, 1998, vol. 339 (pg. 105 - 12 ) © 2003 by the Infectious Diseases Society of America I agree to the terms and conditions. [academic.oup.com]

  In the encephalitic form of rabies the acute neurological syndrome classically includes painful pharyngeal spasms after exposure to a gust of air (aerophobia) or a drink of water (hydrophobia). [infectiousdiseaseadvisor.com]

• Vomiting

  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]

  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]

  During this stage, the individual may have a headache, fever, decreased appetite, vomiting, and general malaise. Pain, itching, and tingling may be experienced at the wound site. [orthoinfo.aaos.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]

• 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]

  […] 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]

  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]

  Symptoms include depression, headache, nausea, seizures, anorexia, muscle stiffness, and increased production of saliva. Abnormal sensations, such as itching, around the site of exposure are a common early symptom. [britannica.com]

• Diarrhea

  Other nonspecific symptoms may occur, including malaise, anorexia, headaches, fever, chills, pharyngitis, nausea, emesis, diarrhea, anxiety, agitation, insomnia and depression. [orpha.net]

  Chronic digestive issues such as Inflammatory Bowel Disease, colitis or chronic diarrhea. Inflammation anywhere in the body, including in the digestive tract, is aggravated by the rabies vaccine. [dogsnaturallymagazine.com]

  Soon afterwards, there is a period of tiredness, possibly with lack of appetite, headache, fever, cough, sore throat, abdominal pain, nausea, vomiting, and diarrhea. [ccohs.ca]

  Early symptoms may also include a sore throat, low-grade fever, headache, loss of appetite, nausea and vomiting, and diarrhea. Painful spasms develop in the muscles that control breathing and swallowing. [medical-dictionary.thefreedictionary.com]

• Abdominal Pain

  Mild-to-moderate problems: Soreness, redness or swelling where the shot was given Headache, nausea, abdominal pain, muscle aches and dizziness Hives, pain in the joints and fever Severe problems (Rare): Deafness Permanent brain damage Serious allergic [walgreens.com]

  Mild problems soreness, redness, swelling, or itching where the shot was given (30% – 74%) headache, nausea, abdominal pain, muscle aches, dizziness (5% – 40%) Moderate problems hives, pain in the joints, fever (about 6% of booster doses) Other nervous [cdc.gov]

  […] nausea, abdominal pain, muscle aches, and dizziness. [wwwnc.cdc.gov]

  Soon afterwards, there is a period of tiredness, possibly with lack of appetite, headache, fever, cough, sore throat, abdominal pain, nausea, vomiting, and diarrhea. [ccohs.ca]

  Patients given the current vaccine reported approximately 30–74% levels of pain, swelling, erythema, and itching around the injection site. 27 Systemic reactions such as headache, nausea, and abdominal pains were reported in 5–40% of recipients, most [emj.bmj.com]

• Dysphagia

  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]

  That evening, the boy was taken to a hospital emergency department (ED) with chest tightness, dysphagia, and insomnia. [cdc.gov]

• 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]

• Chest Pain

  Only a day later, she was back in the hospital with chest pain, shortness of breath, tingling and numbness in her arm and increased anxiety. [livescience.com]

• Foaming at the Mouth

  Once it enters the saliva glands and produces foaming of the mouth, it is considered advanced and highly contagious. Large amounts of the virus are found in saliva and are transmitted when the infected mammal bites an uninfected mammal. [petful.com]

  The pet may experience drooling or foaming at the mouth, which is a classic sign of rabies. 3 - Check your pet's jaw and throat for signs of paralysis. [cuteness.com]

  In its latter stages, rabies causes fever, insomnia, hallucinations, foaming at the mouth, and extreme aggression. [giantmicrobes.com]

  Some animals drool or "foam at the mouth" because they cannot swallow their saliva Can the same signs show up in animals with other diseases? Yes. [kanecountypets.com]

• 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]

  As time progresses, the symptoms turn more severe and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing, and hydrophobia (fear of water). [co.monroe.mi.us]

• Muscle Spasm

  […] paralysis (when a person cannot move some part of the body) extreme sensitivity to bright lights, sounds, or touch Someone with rabies can produce a lot of saliva (spit), and muscle spasms in their throat might make it hard to swallow. [kidshealth.org]

  Later symptoms may include muscle spasms and hydrophobia (fear of water). In an adult, the average incubation period is three to eight weeks. [simcoemuskokahealth.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]

  Prodromal symptoms then develop, including fevers, myalgia, headache, irritability, depression, and upper airway or gastrointestinal symptoms (box 1). [emj.bmj.com]

  An incubation period ranges from 10 days to 1 year and is followed by a prodromal period characterized by fever, malaise, headache, paresthesia, and myalgia. [medical-dictionary.thefreedictionary.com]

  Systemic reactions are generally less common (i.e., 1% to 10% of recipients) and may consist of malaise, myalgia, arthralgia, headache and fever. Lymphadenopathy, nausea and rash have been reported occasionally. [canada.ca]

• 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]

  They may include fever, headache, muscle pain, sore throat, fatigue, nausea, and vomiting. Altered sensation and muscle twitching in the area of the bite are signs that are more suspicious of rabies. [encyclopedia.com]

• 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]

  Other signs include excitation, irritability, photophobia (extreme sensitivity to light) and seizures. In the United States, wild animals are the reservoir for the rabies virus. [coulterah.com]

  […] 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]

  The clinical signs include strange and abnormal behavior, abnormal meowing, eye discomfort in light (photophobia), restless aggression, muscle tremors and lack of coordination. [njaes.rutgers.edu]

• Blurred Vision

  By the fourth day after the onset of symptoms, blurred vision, weakness of the left leg, and a gait abnormality were present. On the fifth day, fever (38.8°C), slurred speech, nystagmus, and tremors of the left arm developed. [nejm.org]

• Pruritus

  The frequency of minor adverse reactions (local pain, erythema, swelling and pruritus) varies widely from one report to another. [who.int]

  Also, during the prodromal period the patient may experience focal symptoms at the portal of innoculation including pain, parasthesias, and pruritus. [infectiousdiseaseadvisor.com]

• 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]

• Aggressive Behavior

  The furious phase is marked by dilated pupils, disorientation and anxious or alert facial expressions. 4 - Monitor your pet's behavior. One of the most obvious signs of rabies is aggressive behavior in an animal. [cuteness.com]

  If you see an animal with unusual or aggressive behavior, stay away and contact your local Animal Control officials. [msdh.ms.gov]

  Rabies can be confused with other conditions that cause aggressive behavior, so a diagnosis is based on history of possible exposure. [petmd.com]

  The Law Regarding Animal Bites (Against Humans) This dog is suspected of being rabid as it had been exhibiting signs of restlessness and overall uncharacteristic aggressive behavior, which are two symptoms of rabies. [veterinarypartner.vin.com]

• 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]

  Rabies in people is a lot like rabies in dogs: It causes confusion, hyperactivity, excessive drooling, and delusions. [nationalgeographic.com]

  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 [dw.de]

  Seizures, delusions and hallucinations then occur, followed by coma and death, usually within a week of the start of the severe symptoms. Careful cleaning of bites and the use of human antirabies globulin and rabies vaccine can prevent the disease. [medical-dictionary.thefreedictionary.com]

• 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]

• Confusion

  Most people become restless, confused, and uncontrollably excited. Their behavior may be bizarre. They may hallucinate and have insomnia. Saliva production greatly increases. [merckmanuals.com]

  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]

  © The Spruce, 2018 General Confusion About Vaccinations There have been lots of discussions (and confusion) about cat and dog vaccinations. How often, what vaccinations are really necessary, do risks outweigh benefits, and so on. [thespruce.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]

  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]

• Seizure

  Few days later she became drowsy and developed recurrent seizures and marked phobic spasms which prompted the treating physician to diagnose human rabies. [ncbi.nlm.nih.gov]

  Animals in the second stage of rabies may not show fear of natural predators and may attack moving objects, other animals and people. 5 - Watch for physical signs of seizures, roaming and trembling. 1 - Watch for signs of choking. [cuteness.com]

  The result is a progression from seizure to coma to death. [datcp.wi.gov]

• 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]

  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]

  In its latter stages, rabies causes fever, insomnia, hallucinations, foaming at the mouth, and extreme aggression. [giantmicrobes.com]

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.

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.

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.

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].

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.

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.

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.

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.

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.

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.