When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Rabies

Última revisão: 12 Dec 2025
Última atualização: 06 Jul 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
Detalhes completos

Outros fatores diagnósticos

  • urinary or fecal incontinence
  • coma
  • abdominal pain
  • insomnia
  • seizures
  • slurred or stuttered speech
  • ataxia
Detalhes completos

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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
Detalhes completos

Investigações a serem consideradas

  • serum arbovirus antibodies
  • serum Bartonella antibodies
  • serum Rickettsia antibodies
  • head MRI
Detalhes completos

Algoritmo de tratamento

Inicial

asymptomatic with recent vector exposure

AGUDA

symptomatic rabies

Colaboradores

Autores

Sergio Recuenco, MD, MPH, DrPH

Associate Professor

Faculty of Medicine Sa Fernando

National University of San Marcos

Lima

Peru

Declarações

SR declares that he has no competing interests.

Rodney Willoughby, MD

Professor

Pediatrics

Medical College of Wisconsin

Milwaukee

WI

Declarações

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

Agradecimentos

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

Declarações

KR declares that she has no competing interests.

Revisores

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

Declarações

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

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.

Key articles

World Health Organization. Weekly epidemiological record. Rabies vaccines: WHO position paper. April 2018 [internet publication].Full text

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].Full text

World Health Organization. WHO expert consultation on rabies: WHO TRS N°1012 (third report). April 2018 [internet publication].Full text

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Rabies images
  • Differentials

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

    • CDC Yellow Book: health information for international travel - rabies
    • Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer