Rabies

Last reviewed: 1 Nov 2022
Last updated: 27 May 2022

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
More key diagnostic factors

Other diagnostic factors

  • urinary or fecal incontinence
  • coma
  • abdominal pain
  • insomnia
  • seizures
  • slurred or stuttered speech
  • ataxia
Other diagnostic factors

Risk factors

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

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
More 1st investigations to order

Investigations to consider

  • serum arbovirus antibodies
  • serum Bartonella antibodies
  • serum Rickettsia antibodies
  • head MRI
More investigations to consider

Treatment algorithm

INITIAL

asymptomatic with recent vector exposure

ACUTE

symptomatic rabies

Contributors

Authors

Sergio Recuenco, MD, MPH, DrPH

Associate Professor

Faculty of Medicine Sa Fernando

National University of San Marcos

Lima

Peru

Disclosures

SR declares that he has no competing interests.

Rodney Willoughby, MD

Professor

Pediatrics

Medical College of Wisconsin

Milwaukee

WI

Disclosures

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

Acknowledgements

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

Disclosures

KR declares that she has no competing interests.

Peer reviewers

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

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.

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

Disclosures

AG declares that he has no competing interests.

  • Rabies images
  • Differentials

    • Herpes simplex virus infection
    • Enterovirus meningoencephalitis
    • West Nile virus encephalitis
    More Differentials
  • Guidelines

    • Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies
    • CDC health information for international travel (The Yellow Book). Chapter 4: infectious diseases related to travel - rabies
    More Guidelines
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