Rabies physical examination: Difference between revisions

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{{Rabies}}
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==Overview==
{{CMG}} {{AE}} {{IQ}}
When a person contracts rabies, they do not show symptoms immediately. The disease take a period of time to manifest in the body which is know as its period of [[incubation]]. Once symptoms arise, the patients condition deteriorates rapidly. There is not a great deal of time available to perform a routine physical examination. A patient will most likely present with some severe symptoms that may be misdiagnosed as diseases such as [[Guillain-Barre syndrome]].


==Physical Exam==
== Overview ==
A patient may present with any of the following conditions:
Common physical examination findings of rabies include [[hyperpyrexia]] alternating with [[hypothermia]], [[tachycardia]], [[respiratory]] collapse, [[hypersalivation]], [[lacrimation]], [[sweating]], [[Pupillary dilation|dilatation of the pupils]] and [[bradycardia]]. Skin findings may include percussion myoedema, bite marks and [[bruises]].


*[[Psychosis]]
== Physical Examination ==
*[[Thrashing]]
*[[Seizures]]
*[[Aphasia]]
*Muscular twitching
*Restlessness
*[[Delirium]]


A patient with rabies may present with difficulty drinking. This is because attempting to drink may cause [[spasms]] of the [[larynx]] and [[diaphragm]].
=== Vital Signs ===
* [[Hyperpyrexia]] alternating with [[hypothermia]]
* [[Tachycardia]] 
* [[Respiratory]] and [[vascular]] collapse
* [[Bradycardia]]
 
=== Skin ===
* Percussion myoedema (mounding of the muscle at the percussion site)<ref name="pmid2883526">{{cite journal |vauthors=Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S |title=Myoedema as a clinical sign in paralytic rabies |journal=Lancet |volume=1 |issue=8543 |pages=1210 |year=1987 |pmid=2883526 |doi= |url=}}</ref>
* Bite marks
* [[Bruises]]
 
=== HEENT ===
* [[Hypersalivation]]
*[[Lacrimation]]
*[[Sweating]]
*[[Pupillary dilation|Dilatation of the pupils]]
 
=== Neck ===
* No abnormal findings
 
=== Lungs ===
* Fine/coarse [[crackles]] upon [[auscultation]] of the [[lung]] bases/apices unilaterally/bilaterally, if [[Aspirate|aspirated]].
* [[Wheezing]] may be present due to [[aspiration]] or  [[chest]] [[infection]]
* Normal/reduced [[tactile fremitus]]
 
=== Heart ===
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]] normal, soft
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]] normal
 
=== Abdomen ===
* [[Guarding]] may be present
 
=== Genitourinary ===
* No abnormal findings
 
=== Neuromuscular ===
* [[Opisthotonos]]
* [[Altered mental status]]
* Increased [[Tendon reflex|tendon reflexes]] with [[Extensor plantar reflexes|extensor plantar responses]]
*[[Flaccid paralysis]] with generalized [[areflexia]] when patient develops [[coma]]
* [[Nuchal rigidity]]
* Increased [[muscle tone]]
* [[Fasciculations]]
 
=== Extremities ===
* Bite marks
* Muscle [[atrophy]]
* [[Fasciculations]] in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Viral diseases]]
[[Category:Mononegavirales]]
[[Category:Neurology]]
[[Category:Zoonoses]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Infectious disease]]
[[Category:Medicine]]

Latest revision as of 23:56, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Common physical examination findings of rabies include hyperpyrexia alternating with hypothermia, tachycardia, respiratory collapse, hypersalivation, lacrimation, sweating, dilatation of the pupils and bradycardia. Skin findings may include percussion myoedema, bite marks and bruises.

Physical Examination

Vital Signs

Skin

  • Percussion myoedema (mounding of the muscle at the percussion site)[1]
  • Bite marks
  • Bruises

HEENT

Neck

  • No abnormal findings

Lungs

Heart

  • S1 normal, soft
  • S2 normal

Abdomen

Genitourinary

  • No abnormal findings

Neuromuscular

Extremities

References

  1. ↑ Hemachudha T, Phanthumchinda K, Phanuphak P, Manutsathit S (1987). "Myoedema as a clinical sign in paralytic rabies". Lancet. 1 (8543): 1210. PMID 2883526.

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