Last reviewed: 21 Aug 2021
Last updated: 27 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • hydrophobia
  • aerophobia
  • limb numbness, pain, and paraesthesia
  • pruritus
  • dysphagia
  • fever
  • change in behaviour
  • agitation and confusion
  • hallucination
  • signs of autonomic instability
  • rapid progression of symptoms
  • weakness and paralysis

Other diagnostic factors

  • urinary or faecal incontinence
  • coma
  • abdominal pain
  • insomnia
  • seizures
  • slurred or stuttered speech
  • ataxia

Risk factors

  • recent scratch or bite from a known vector
  • travel to/living in rabies-endemic country
  • occupational or recreational exposure
  • age <15 years

Diagnostic investigations

1st investigations to order

  • saliva PCR and viral culture
  • skin biopsy (neck) with direct fluorescent antibody (DFA) and PCR
  • CSF cytology
  • CSF biochemistry
  • CSF rabies neutralising antibody
  • serum rabies IgM or IgG
  • CSF herpes simplex PCR
  • CSF enterovirus PCR
  • CSF West Nile virus IgM
  • serum N-methyl-D-aspartate (NMDA) glutamate receptor antibodies

Investigations to consider

  • serum arbovirus antibodies
  • serum Bartonella antibodies
  • serum Rickettsia antibodies
  • head MRI

Treatment algorithm

Contributors

Authors

Sergio Recuenco, MD, MPH, DrPH

Associate Professor

Faculty of Medicine Sa Fernando

National University of San Marcos

Lima

Peru

Disclosures

SR declares that he has no competing interests.

Rodney Willoughby, MD

Professor

Pediatrics

Medical College of Wisconsin

Milwaukee

WI

Disclosures

RW is an author of a number references cited in this topic.

Acknowledgements

Dr Sergio Recuenco and Dr Rodney Willoughby would like to gratefully acknowledge Dr Kis Robertson, a previous contributor to this topic.

Disclosures

KR declares that she has no competing interests.

Peer reviewers

Peter Leggat, MD

Head

School of Public Health

Tropical Medicine and Rehabilitation Sciences

Faculty of Medicine

Health and Molecular Sciences

James Cook University

Townsville

Queensland

Australia

Disclosures

PL is a member of the Australian Travel Health Advisory Group that is supported by a grant from GlaxoSmithKline. PL has received travel grants from GlaxoSmithKline to attend travel medical conferences in the last 5 years.

Allan Grill, MD, CCFP, MPH

Assistant Professor

Department of Family and Community Medicine

Dalla Lana School of Public Health

University of Toronto

Toronto

Ontario

Canada

Disclosures

AG declares that he has no competing interests.

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