Rabies history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History and Symptoms[edit | edit source]

• The majority of patients with [disease name] are asymptomatic.

OR

• The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
• Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History[edit | edit source]

The following points need to be asked about while taking a history from patients with suspected rabies:

• Details about the interaction with the animal
• Any unusual behavior by the animal
• Whether the animal is available or not for testing
• Vaccination status of the animal

Symptoms[edit | edit source]

The symptoms depend upon the stage of the disease at which it presents. It may present at any one of the following stages:

1. Incubation period
2. Prodromal period
3. Acute neurologic period (Clinical rabies)
4. Coma

Incubation period

• During this period, the patient is asymptomatic as the virus has not entered the CNS yet.
• Antibody response may not be observed during this 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.
• Following factors are found to be associated with a shorter incubation period:
  • Bite on head or face (richly innervated areas)
  • Multiple bites transferring heavy inoculum
  • Deep and large woundsInadequate rabies prophylaxis, or an unknown new exposure may lead to a longer incubation period.
  • It is hypothesized that a latent viral infection and/or slow replication may be associated with it.

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)
• Pathognomic presentation involves following symptoms at the inoculation site:
  • 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:

• Photophobia

Acute neurologic period (Clinical rabies)

• Clinical rabies has two forms, both of them evolving from prodromal symptoms

1. Encephalitic ("furious") rabies- more common (80% cases)
2. Paralytic ("dumb") rabies

• Occasionally atypical cases with following features have been reported:
  • Sensory or motor deficits
  • Choreiform movements of the bitten limb (during the prodromal phase)
  • Focal brainstem signs
  • Cranial nerve palsies
  • Myoclonus
  • Seizure

• 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:

• Hydrophobia
• Aerophobia
• Facial grimace
• Opisthotonos
• Autonomic instability- lacrimation, hypersalivation
• Dysarthria
• Dysphagia
• Diplopia
• Vertigo
• Agitation
• Combativeness

(b) Paralytic ("dumb") rabies:

Prodromal symptoms may be followed by flaccid paralysis

References[edit | edit source]

Category:

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