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Rabies

Last reviewed: 14 Jan 2026
Last updated: 06 Jul 2023

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • history of recent scratch or bite from known vector
  • hydrophobia
  • aerophobia
  • limb numbness, pain, and paresthesia
  • pruritus
  • dysphagia
  • fever
  • change in behavior
  • agitation and confusion
  • hallucination
  • signs of autonomic instability
  • rapid progression of symptoms
  • weakness and paralysis
Detalhes completos

Outros fatores diagnósticos

  • urinary or fecal incontinence
  • coma
  • abdominal pain
  • insomnia
  • seizures
  • slurred or stuttered speech
  • ataxia
Detalhes completos

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • saliva PCR and viral culture
  • skin biopsy (neck) with direct fluorescent antibody (DFA) and PCR
  • CSF cytology
  • CSF biochemistry
  • CSF rabies neutralizing 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
Detalhes completos

Investigações a serem consideradas

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

Algoritmo de tratamento

Inicial

asymptomatic with recent vector exposure

AGUDA

symptomatic rabies

Colaboradores

Autores

Sergio Recuenco, MD, MPH, DrPH

Associate Professor

Faculty of Medicine Sa Fernando

National University of San Marcos

Lima

Peru

Declarações

SR declares that he has no competing interests.

Rodney Willoughby, MD

Professor

Pediatrics

Medical College of Wisconsin

Milwaukee

WI

Declarações

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

Agradecimentos

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

Declarações

KR declares that she has no competing interests.

Revisores

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

Declarações

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

Declarações

AG declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

World Health Organization. Weekly epidemiological record. Rabies vaccines: WHO position paper. April 2018 [internet publication].Texto completo

Centers for Disease Control and Prevention. Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices - United States, 2022. May 2022 [internet publication].Texto completo

World Health Organization. WHO expert consultation on rabies: WHO TRS N°1012 (third report). April 2018 [internet publication].Texto completo

Rupprecht CE, Briggs D, Brown CM, et al; Centers for Disease Control and Prevention. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010;59:1-9.Texto completo  Resumo

Willoughby RE Jr, Tieves KS, Hoffman GM, et al. Survival after treatment of rabies with induction of coma. N Engl J Med. 2005;352:2508-2514.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Rabies images
  • 鉴别诊断

    • Herpes simplex virus infection
    • Enterovirus meningoencephalitis
    • West Nile virus encephalitis
    Mais Diagnósticos diferenciais
  • 指南

    • CDC Yellow Book: health information for international travel - rabies
    • Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies
    Mais 指南
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