Rabies is a notifiable disease in the US.
Preventable through prompt medical care. Postexposure prophylaxis with wound cleansing, immunization, and rabies immune globulin is highly effective at preventing the disease when given promptly and properly.
Symptoms begin with a nonspecific prodromal illness. In encephalitic rabies, this is followed by early-onset behavioral changes and late-onset paralysis. In the paralytic form, the behavioral changes are absent.
Almost always fatal following onset of clinical signs. The disease is rapidly progressive, leading to death within 2 weeks in most cases. Some survivors have been reported.
Pre-exposure prophylaxis is recommended for certain people at high risk for exposure.
An acute viral encephalomyelitis caused by the rabies virus and other members of the Lyssavirus genus, which is transmitted by animal bites, mainly dogs in developing countries and bats in other countries including the US.
The World Health Organization (WHO) has set a global goal to achieve no human deaths from dog-transmitted rabies by 2030.
History and exam
Key diagnostic factors
- history of recent scratch or bite from known vector
- limb numbness, pain, and paresthesia
- change in behavior
- agitation and confusion
- signs of autonomic instability
- rapid progression of symptoms
- weakness and paralysis
Other diagnostic factors
- urinary or fecal incontinence
- abdominal pain
- slurred or stuttered speech
- recent scratch or bite from known vector
- travel to/living in rabies-endemic country
- occupational or recreational exposure
- age <15 years
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 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
Investigations to consider
- serum arbovirus antibodies
- serum Bartonella antibodies
- serum Rickettsia antibodies
- head MRI
asymptomatic with recent vector exposure
- Herpes simplex virus infection
- Enterovirus meningoencephalitis
- West Nile virus encephalitis
- 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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