What are the signs and symptoms of rabies in the acute neurologic period?

Updated: Jun 21, 2019
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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This period is associated with objective signs of developing CNS disease; however, consciousness remains unaffected until the onset of coma. The duration is 2-7 days. Symptoms include muscle fasciculations, priapism, and focal or generalized convulsions. Patients may die immediately or may progress to paralysis, which may be present only in the bitten limb at first but usually becomes diffuse.

Two-thirds of human rabies cases acquired from dogs manifest as "furious rabies." Patients develop agitation, hyperactivity, restlessness, thrashing, biting, confusion, or hallucinations. After several hours to days, this becomes episodic and interspersed with calm, cooperative, lucid periods. Furious episodes last less than 5 minutes. Episodes may be triggered by visual, auditory, or tactile stimuli or may be spontaneous. Seizures may occur. This phase may end in cardiorespiratory arrest or may progress to paralysis.

The remaining one-third of patients with rabies develop paralytic rabies, also known as dumb rabies or apathetic rabies, because the patient is relatively quiet compared with a person with the furious form. Paralysis occurs from the outset, and fever and headache are prominent. Paralytic rabies may initially mimic Guillain-Barré syndrome (GBS) with ascending lower–motor-neuron weakness unpreceded by classic "mad" signs, and rabies should be considered in the differential diagnosis of GBS. [26]

Bat-associated rabies often manifests with more atypical findings.

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