Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ History of animal bite 10 days to 1 year (usually < 90 days) previously Paresthesias or hyperesthesia in bite area Progressive limb and facial weakness in some patients (dumb rabies; 30%) Irritability followed by fever, confusion, combativeness, muscle spasms (especially pharyngeal with swallowing) in all patients (furious rabies) Rabies antigen detected in corneal scrapings or tissue obtained by brain or skin biopsy; Negri bodies seen in brain tissue +++ Clinical Findings ++ Paresthesia at the bite site is usually the first symptom Nonspecific anxiety, excitability, or depression follows, then muscle spasms, drooling, hydrophobia, delirium, and lethargy Swallowing or even the sensation of air blown on the face may cause pharyngeal spasms Seizures, fever, cranial nerve palsies, coma, and death follow within 7–14 days after onset +++ Diagnosis ++ Leukocytosis is common CSF is usually normal, but may show elevation of protein and mononuclear cell pleocytosis Cerebral imaging and electroencephalography are not diagnostic Infection in an animal may be determined by use of the fluorescent antibody test to examine brain tissue for antigen Classic Negri cytoplasmic inclusion bodies in brain tissue are not always present Seroconversion measured by neutralizing antibody occurs after 7–10 days and clinical recovery has been associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system +++ Treatment ++ Survival is very rare but has been reported in a very small number of patients receiving meticulous intensive care and the Milwaukee protocol that focuses on the altered central nervous system metabolic state Early diagnosis is important for the protection and postexposure prophylaxis of patient contacts Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.