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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Michael Maddaleni, B.S.
Overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[3]
Overview
The symptoms of rabies depend upon the stage of the disease at the time of presentation. Rabies may present during incubation period, prodromal period, acute neurologic period (clinical rabies), or coma. Patients are asymptomatic during the incubation period. Prodromal symptoms may include low-grade fever, chills, malaise, myalgias, weakness, fatigue, anorexia, sore throat, nausea, vomiting and headache. Clinical rabies can present as encephalitic ("furious") rabies or paralytic ("dumb") rabies. Encephalitic rabies is more common and presents as hydrophobia, aerophobia, facial grimace, opisthotonos, autonomic instability, dysarthria, dysphagia, and diplopia. Rabies eventually results in progressive encephalopathy, respiratory arrest, coma and death within 10 days of the onset of symptoms.
History and Symptoms
History
The following aspects must be inquired about while taking a history from patients with suspected rabies:
- Details about the interaction with the animal
- Any unusual behavior by the animal
- Availability of the animal for testing
- Vaccination status of the animal[1]
Symptoms
The symptoms of rabies depend upon the stage of the disease at the time of presentation. Rabies may present at any one of the following stages:
- Incubation period
- Prodromal period
- Acute neurologic period (clinical rabies)
- Coma
Incubation period
- During incubation period, the patient is asymptomatic as the virus has not yet entered the central nervous system (CNS).
- Antibody response may not be observed during incubation period as the virus is still isolated from the immune system.
- The duration of incubation period varies. The average duration is 20-90 days but can range from a few days to many years.[2][3][4][5]
Factors associated with a shorter incubation period:
The following factors are associated with a shorter incubation period:
- Bite on head or face (richly innervated areas)
- Multiple bites transferring heavy inoculum
- Deep and large wounds
Factors associated with a longer incubation period:
The following factors are associated with a longer incubation period:
- Inadequate rabies prophylaxis
- Unknown new exposure
Prodromal period
- In this stage, the patient presents with non-specific signs and symptoms and rabies usually remains unsuspected at this stage
- It usually lasts from a few days to a week (3-9days)[8]
- Pathognomic presentation involves following symptoms at the inoculation site:[9]
- Pain
- Paresthesia
- Itching
- Tingling or burning
- Numbness
Common symptoms include:
- Low-grade fever
- Chills
- Malaise
- Myalgias
- Weakness
- Fatigue
- Anorexia
- Sore throat
- Nausea
- Vomiting
- Headache
- Anxiety
- Agitation
- Insomnia
- Depression
Less common symptoms:
Acute neurologic period (Clinical rabies)
- Clinical rabies has two forms, both of them evolving from prodromal symptoms
- Encephalitic ("furious") rabies- more common (80% cases)
- Paralytic ("dumb") rabies
- Following factors influence the course of disease:
- The depth and extent of bite
- Proximity to head
- Amount of secretions encountered at the site of bite
(a) Encephalitic ("furious") rabies:
This form usually involves short episodes (furious episodes) of hyperactivity, restlessness, and agitation lasting about 5 minutes, followed by calm and lucid intervals. Furious episodes may occur spontaneously or may be triggered by stimuli such as visual, auditory or tactile. Common symptoms include:[11][8]
- Hydrophobia
- Aerophobia
- Facial grimace
- Opisthotonos
- Autonomic instability
- Dysarthria
- Dysphagia
- Diplopia
- Vertigo
- Agitation
- Combativeness
Less common symptoms:
- Hallucinations
- Seizures (generalized)
(b) Paralytic ("dumb") rabies:
Prodromal symptoms may be followed by flaccid paralysis that may be symmetrical/asymmetrical and needs to be differentiated from Guillain-Barré syndrome.
Common symptoms:
- Flaccid paralysis in the bitten limb followed by ascending paralysis and
- Dense paraplegia
- Loss of sphincter tone
- Subsequent paralysis of the muscles of deglutition and respiration, leading to death.
- Headache
- Pain in the affected muscle
- Abnormal sensation in the affected muscle
Less common symptoms:
Coma
- Rabies eventually results in progressive encephalopathy, respiratory arrest, coma and death within 10 days of the onset of symptoms.[7][12]
References
- ↑ "Compendium of animal rabies prevention and control, 2004: National Association of State Public Health Veterinarians, Inc. (NASPHV)". MMWR Recomm Rep. 53 (RR-9): 1–8. 2004. PMID 15215738.
- ↑ Knobel DL, Cleaveland S, Coleman PG, Fèvre EM, Meltzer MI, Miranda ME, Shaw A, Zinsstag J, Meslin FX (2005). "Re-evaluating the burden of rabies in Africa and Asia". Bull. World Health Organ. 83 (5): 360–8. doi:/S0042-96862005000500012 Check
|doi=value (help). PMC 2626230. PMID 15976877. - ↑ Noah DL, Drenzek CL, Smith JS, Krebs JW, Orciari L, Shaddock J, Sanderlin D, Whitfield S, Fekadu M, Olson JG, Rupprecht CE, Childs JE (1998). "Epidemiology of human rabies in the United States, 1980 to 1996". Ann. Intern. Med. 128 (11): 922–30. PMID 9634432.
- ↑ Rupprecht CE, Hanlon CA, Hemachudha T (2002). "Rabies re-examined". Lancet Infect Dis. 2 (6): 327–43. PMID 12144896.
- ↑ 5.0 5.1 Boland TA, McGuone D, Jindal J, Rocha M, Cumming M, Rupprecht CE, Barbosa TF, de Novaes Oliveira R, Chu CJ, Cole AJ, Kotait I, Kuzmina NA, Yager PA, Kuzmin IV, Hedley-Whyte ET, Brown CM, Rosenthal ES (2014). "Phylogenetic and epidemiologic evidence of multiyear incubation in human rabies". Ann. Neurol. 75 (1): 155–60. doi:10.1002/ana.24016. PMC 4118733. PMID 24038455.
- ↑ Smith JS, Fishbein DB, Rupprecht CE, Clark K (1991). "Unexplained rabies in three immigrants in the United States. A virologic investigation". N. Engl. J. Med. 324 (4): 205–11. doi:10.1056/NEJM199101243240401. PMID 1985241.
- ↑ 7.0 7.1 Hemachudha T, Ugolini G, Wacharapluesadee S, Sungkarat W, Shuangshoti S, Laothamatas J (2013). "Human rabies: neuropathogenesis, diagnosis, and management". Lancet Neurol. 12 (5): 498–513. doi:10.1016/S1474-4422(13)70038-3. PMID 23602163.
- ↑ 8.0 8.1 8.2 Hemachudha T, Laothamatas J, Rupprecht CE (2002). "Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges". Lancet Neurol. 1 (2): 101–9. PMID 12849514.
- ↑ "Imported human rabies in a U.S. Army soldier - New York, 2011". MMWR Morb. Mortal. Wkly. Rep. 61 (17): 302–5. 2012. PMID 22552206.
- ↑ "Recovery of a patient from clinical rabies--Wisconsin, 2004". MMWR Morb. Mortal. Wkly. Rep. 53 (50): 1171–3. 2004. PMID 15614231.
- ↑ Hankins DG, Rosekrans JA (2004). "Overview, prevention, and treatment of rabies". Mayo Clin. Proc. 79 (5): 671–6. doi:10.1016/S0025-6196(11)62291-X. PMID 15132411.
- ↑ Hattwick MA (1972). "Reactions to rabies". N. Engl. J. Med. 287 (23): 1204. PMID 5082226.
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