Rabies - Bulletin - Europe

Rabies Information System of the WHO

Clinical signs

Clinical signs in animals

All animals exhibit certain neurological signs as a result of rabies. From species to species these symptoms may differ slightly.

Prodromal stage: After a certain incubation period, the onset of clinical symtoms follows. During this first stage which usually lasts for about 1-3 days minor behavioural changes might occur, i.g agressiveness in tame animals, daytime activities in nocturnal animals, no fear of humans in wild animals or abnormalities in appetite.

Excitative (furious) phase: Eventually, the prodromal stage is follwed by a period of severe agitation and agressiveness. The animal often bites any material. Rabid dogs, for example, may develop a typical high barking sound during furious rabies. Death may follow convulsions even without the paralytic stage of the disease.

Paralytic (dumb) phase: This stage is characterized by the inability to swallow, leading to a typical sign of foaming saliva around the mouth. Some animals may develop paralysis beginning at the hind extremities. Eventually, complete paralysis is followed by death.

Clinical signs in humans

It is very difficult to differentiate rabies in humans from other diseases by clinical examination. In rabies-endemic countries rabies should always be suspected when neurological symptoms follow an animal bite. After the incubation period a 2–10 days prodromal period of nonspecific symptoms is followed. The first clinical symptom is usually neuropathic pain at the wound site. Further symptoms which may include tiredness, weakness, loss of appetite, headache, fever and other aches suggest involvement of the respiratory, gastrointestinal and/or central nervous systems.

During the acute stage of the disease two different forms may occur. Furious rabies is characterized by hydrophobia or aerophobia, hyperactivity and fluctuating consciousness. Paralytic rabies runs a less dramatic course, but the final outcome is the same. Rabies is inevitably fatal and death occurs during the first seven days of illness without intensive care due to respiratory failure.

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