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Rabies

最后审阅: 10 Jun 2025
最后更新: 06 Jul 2023

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
完整详情

其他诊断因素

  • urinary or fecal incontinence
  • coma
  • abdominal pain
  • insomnia
  • seizures
  • slurred or stuttered speech
  • ataxia
完整详情

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
完整详情

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
完整详情

需考虑的检查

  • serum arbovirus antibodies
  • serum Bartonella antibodies
  • serum Rickettsia antibodies
  • head MRI
完整详情

治疗流程

初步治疗

asymptomatic with recent vector exposure

急症处理

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
  • Rabies images
  • 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
    更多 指南
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