Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- hidrofobia
- aerofobia
- dormência, dor e parestesia dos membros
- prurido
- disfagia
- febre
- alteração no comportamento
- agitação e confusão
- alucinação
- sinais de instabilidade autonômica
- rápida evolução dos sintomas
- fraqueza e paralisia
Other diagnostic factors
- incontinência urinária ou fecal
- coma
- dor abdominal
- insônia
- convulsões
- fala indistinta ou gagueira
- ataxia
Risk factors
- arranhadura ou mordida recente de um vetor conhecido
- visita/residência em países com raiva endêmica
- exposição ocupacional ou recreacional
- idade <15 anos
Diagnostic tests
1st tests to order
- reação em cadeia da polimerase e cultura viral da saliva
- biópsia da pele (pescoço) com teste de anticorpo fluorescente direto (AFD) e reação em cadeia da polimerase
- citologia do líquido cefalorraquidiano (LCR)
- bioquímica do LCR
- anticorpos neutralizantes da raiva no LCR
- imunoglobulina M (IgM) ou G (IgG) sérica da raiva
- reação em cadeia da polimerase para herpes simples no LCR
- reação em cadeia da polimerase para enterovírus no LCR
- imunoglobulina M (IgM) do vírus do Nilo Ocidental no líquido cefalorraquidiano (LCR)
- anticorpos séricos para receptor de glutamato N-metil-D-aspartato (NMDA)
Tests to consider
- anticorpos séricos para arbovírus
- anticorpos séricos para Bartonella
- anticorpos séricos para Rickettsia
- ressonância nuclear magnética (RNM) do crânio
Treatment algorithm
assintomático com exposição recente ao vetor
raiva sintomática
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 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.
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
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.
Differentials
- Infecção pelo vírus do herpes simples
- Meningoencefalite por enterovírus
- Encefalite do vírus do Nilo Ocidental
More DifferentialsGuidelines
- Guidelines on managing rabies post-exposure
- CDC Yellow Book: health information for international travel - rabies
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer