Summary

• An acute viral encephalomyelitis caused by the rabies virus and other members of the Lyssavirus genus.
• Transmitted by animal bites, especially from dogs in developing countries, and from bats and other wildlife in the US.
• The incubation period is highly variable, ranging from 5 days to 7 years.
• Rabies post-exposure prophylaxis with wound cleansing, immunisation, and rabies immunoglobulin is highly effective at preventing the disease when given promptly and properly.
• Symptoms begin with a non-specific prodromal illness. In encephalitic rabies, this is followed by early-onset behavioural changes and late-onset paralysis. In the paralytic form, the behavioural changes are absent. Atypical, less severe forms of rabies are beginning to be described.
• Specific signs include hydrophobia, aerophobia, and paraesthesias at the site of the bite wound.
• The disease is incurable and rapidly progressive, leading to death within 2 weeks. The standard therapy is palliation.