Summary
Definition
History and exam
Key diagnostic factors
- 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
Other diagnostic factors
- urinary or fecal incontinence
- coma
- abdominal pain
- insomnia
- seizures
- slurred or stuttered speech
- ataxia
Risk factors
- recent scratch or bite from 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 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
Treatment algorithm
Contributors
Authors
General Director
National Center for Public Health
National Health Institute
Lima
Peru
Disclosures
SR declares that he has no competing interests.
Professor
Pediatrics
Medical College of Wisconsin
Milwaukee
WI
Disclosures
The Medical College of Wisconsin receives funds for research grants related to rabies. RW provides advice to teams treating human rabies and is an author of a number of references cited in this monograph.
Dr Sergio Recuenco and Dr Rodney Willoughby would like to gratefully acknowledge Dr Kis Robertson, a previous contributor to this monograph. KR declares that she has no competing interests.
Peer reviewers
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.
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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