小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 恐水
- 恐风
- 肢体麻木、疼痛、感觉异常
- 瘙痒
- 吞咽困难
- 发热
- 行为改变
- 激惹和意识混乱
- 幻觉
- 自主神经功能紊乱的体征
- 病情快速进展
- 无力和麻痹
其他诊断因素
- 大小便失禁
- 昏迷
- 腹痛
- 失眠
- 惊厥
- 发音含糊、口齿不清
- 共济失调
危险因素
- 最近被已知感染宿主抓伤或咬伤
- 前往/居住于狂犬病流行国家
- 职业或娱乐休闲暴露
- 年龄 <15 岁
诊断性检查
首要检查
- 唾液PCR检查和病毒培养
- 皮肤活检（颈部）检测直接荧光抗体（DFA）和聚合酶链反应
- 脑脊液细胞学
- 脑脊液生化
- CSF狂犬病病毒中和抗体
- 狂犬病血清IgM或IgG抗体
- 脑脊液单纯疱疹病毒PCR检查
- 脑脊液肠病毒PCR检测
- 脑脊液西尼罗河病毒 IgM
- 血清N-甲基-D-天门冬氨酸（NMDA）谷氨酸受体抗体
需考虑的检查
- 血清虫媒病毒抗体
- 血清巴尔通氏体属抗体
- 血清立克次氏体抗体
- 头部 MRI
治疗流程
有近期带菌者暴露的无症状患者
有症状的狂犬病
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 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.
鉴别诊断
- 单纯疱疹病毒感染
- 肠病毒性脑膜脑炎
- 西尼罗河病毒性脑炎
更多 鉴别诊断指南
- 暴露后狂犬病管理指南
- CDC 黄皮书：国际旅行健康信息——狂犬病
更多 指南
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