小结
定义
病史和体格检查
关键诊断因素
- 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
其他诊断因素
- urinary or fecal incontinence
- coma
- abdominal pain
- insomnia
- seizures
- slurred or stuttered speech
- ataxia
危险因素
- recent scratch or bite from known vector
- travel to/living in rabies-endemic country
- occupational or recreational exposure
- age <15 years
诊断性检查
首要检查
- 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
需考虑的检查
- serum arbovirus antibodies
- serum Bartonella antibodies
- serum Rickettsia antibodies
- head MRI
治疗流程
asymptomatic with recent vector exposure
symptomatic rabies
撰稿人
作者
Sergio Recuenco, MD, MPH, DrPH
Associate Professor
Faculty of Medicine Sa Fernando
National University of San Marcos
Lima
Peru
利益声明
SR declares that he has no competing interests.
Rodney Willoughby, MD
Professor
Pediatrics
Medical College of Wisconsin
Milwaukee
WI
利益声明
RW is an author of a number of references cited in this topic.
鸣谢
Dr Sergio Recuenco and Dr Rodney Willoughby would like to gratefully acknowledge Dr Kis Robertson, a previous contributor to this topic.
利益声明
KR declares that she has no competing interests.
同行评议者
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
利益声明
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
利益声明
AG declares that he has no competing interests.
参考文献
关键文献
World Health Organization. Weekly epidemiological record. Rabies vaccines: WHO position paper. April 2018 [internet publication].全文
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].全文
World Health Organization. WHO expert consultation on rabies: WHO TRS N°1012 (third report). April 2018 [internet publication].全文
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.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Herpes simplex virus infection
- Enterovirus meningoencephalitis
- West Nile virus encephalitis
更多 鉴别诊断指南
- CDC Yellow Book: health information for international travel - rabies
- Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies
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