Symptoms of Rabies

The list of signs and symptoms mentioned in various sources for Rabies includes the 65
symptoms listed below:
Mental depression - for a short period
Restlessness
Itching - around the bite site
Headache
Fever
Tiredness
Malaise
Nausea
Sore throat
Loss of appetite
Depression
Irritability
Stiff muscles
Pupil dilation
Increased saliva
Drooling
Sound sensitivity
Light sensitivity
Temperature sensitivity
Symptoms of progressing rabies include the following extremely serious life-threatening
symptoms:
o Episodic mania
o Episodic calm
o Restlessness
o Feverishness
o Convulsions
o Painful throat spasms
o Difficulty swallowing
o Hydrophobia (fear of water) - an irrational reaction or spasm on seeing or
drinking water
o Progressive paralysis
o Cardiac failure
o Respiratory failure
Symptoms of animals with rabies include:
o Change in behavior
o Fever
o Loss of appetite
o Change in phonation
o Changed dog bark tone
o Restlessness
o Agitatation
o Trembling
o Barking
o Growling
o Aggression
o Attacking
o Jaw paralysis
o Drooling
o Foaming saliva
o Convulsions
o Paralysis
Chills
Aching muscles
Confusion
Seizures
Delirium
Abnormal behavior
Brain inflammation
Excessive saliva production
Irrational fear of water
Feeling of panic
Feeling of terror
Feeling of dread
Rapid heartbeat
Shortness of breath
Anxiety
Extreme avoidance measures taken
Rabies: Complications
Review medical complications possibly associated with Rabies:
Brain infection
Cardiac failure
Respiratory failure
Death - about 80% of cases
Coma
more complications...
Home Diagnostic Testing
Home medical tests related to Rabies:
Nerve Neuropathy: Related Home Testing:
o Home Diabetes Test Kits
o Home Blood Glucose Testing Kits
Brain & Neurological Disorders: Related Home Testing:
o ADHD -- Home Tests
o Drug Screening Kits
Rabies: Onset and Incubation
Incubation period for Rabies: Typically 30-50 days after exposure; as fast as 14 days for a
severe bite or multiple bites; a year or longer is rare but possible.
Incubation period for Rabies: When symptoms do appear, it is usually 30 to 50 days
following exposure. There is a direct relationship between how severe the bite is and where on
the body the person bitten and how long it takes for symptoms to appear. For example, if a
person's head is severely bitten, symptoms may show up in as few as 14 days. Under rare
conditions, a person may not have symptoms for a year or longer after exposure to the virus.
(Source: excerpt from Rabies, NIAID Fact Sheet: NIAID)
Medication Summary
Before the onset of rabies symptoms, passive and active immunizations are effective in
preventing progression to full-blown rabies.
If the patient has had no prior rabies vaccination, if he or she is of unknown status, or if more
than 5 years have passed since his or her last vaccination, rabies vaccine and immunoglobulin
should be administered as follows (these dosages being applicable to products available in the
United States):
Rabies vaccine IM (deltoid) - 1 mL on days on days 0, 3, 7, and 14 (if immunocompromised,
add an additional dose: 1 mL IM deltoid on days 0, 3, 7, 14, and 28)
Rabies immunoglobulin - 20 IU/kg infiltrated as much as feasible around and under the bite
wound; if any left over, give IM (gluteus)
If the patient has had prior rabies vaccination, vaccine should be administered as follows (this
dosage again being applicable to US vaccine): Rabies vaccine IM (deltoid) 1 mL on days on
days 0 and 3.
Next Section: Passive Immunizing Agents
Treatment
There is no specific treatment for rabies infection. Though a small number of people have
survived rabies, the disease is usually fatal. For that reason, anyone thought to have been
exposed to rabies receives a series of shots to prevent the infection from taking hold.
Treatment for people bitten by animals with rabies
If you've been bitten by an animal that is known to have rabies, you'll receive a series of shots to
prevent the rabies virus from infecting you. If the animal that bit you can't be found, it may be
safest to assume that the animal has rabies. But this will depend on several factors, such as the
type of animal and the situation in which the bite occurred.
Rabies shots include:
A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. Part of this
injection is given near the area where the animal bit you if possible, as soon as possible after
the bite.
A series of rabies vaccines to help your body learn to identify and fight the rabies virus. Rabies
vaccines are given as injections in your arm. You receive five injections over 14 days.
Rabies Vaccines and Immunoglobulin Available in the United
States
Type Name Route Indications
Human Diploid
Cell Vaccine
(HDCV)
Imovax
Rabies
Intramuscular
Preexposure or
Postexposure
Purified Chick
Embryo Cell
Vaccine (PCEC)
RabAvert Intramuscular
Preexposure or
Postexposure
Human Rabies
Immune Globulin
Imogam
Rabies-HT
Local infusion at wound site, with
additional amount intramuscular at
site distant from vaccine
Postexposure
Human Rabies
Immune Globulin
HyperRab TM
S/D
Local infusion at wound site, with
additional amount intramuscular at
site distant from vaccine
Postexposure
Postexposure Prophylaxis for Non-immunized Individuals
Treatment Regimen
Wound
cleansing
All postexposure prophylaxis should begin with immediate thorough cleansing
of all wounds with soap and water. If available, a virucidal agent such as
povidine-iodine solution should be used to irrigate the wounds.
RIG
If possible, the full dose should be infiltrated around any wound(s) and any
remaining volume should be administered IM at an anatomical site distant
from vaccine administration. Also, RIG should not be administered in the
same syringe as vaccine. Because RIG might partially suppress active
production of antibody, no more than the recommended dose should be given.
Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14.
Postexposure Prophylaxis for Previously Immunized
Individuals
Treatment Regimen
Wound
cleansing
All postexposure prophylaxis should begin with immediate thorough cleansing of
all wounds with soap and water. If available, a virucidal agent such as povidine-
iodine solution should be used to irrigate the wounds.
RIG RIG should not be administered.
Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area), one each on days 0 and 3.
Herbs, supplements and vitamins
Aloe
Arginine
Beta-carotene
Black cohosh
Chocolate
Chondroitin sulfate
Coca
Coenzyme Q10
Cranberry
Creatine
DHEA
Dong quai
Echinacea
Ephedra
Evening primrose oil
Flaxseed and flaxseed oil
Folate
Ginkgo
Glucosamine
Honey
Lactobacillus acidophilus
Lycopene
Marijuana
Melatonin
Milk thistle
Niacin
Omega-3 fatty acids, fish oil, alpha-linolenic acid
Red yeast rice
SAMe
Saw palmetto
Soy
St. John's wort
Tea tree oil
Thiamin
Vitamin A
Vitamin B12
Vitamin B6
Vitamin C
Vitamin D
Vitamin E
Whey protein
Zinc
Medical Treatment After Symptom Onset
Inpatient care
Symptomatic rabies cannot be managed in the outpatient setting. Intensive cardiopulmonary
supportive care is the only treatment available for patients with symptomatic rabies. Rabies
vaccination and administration of HRIG is ineffective at this point. In animal studies, rabies
immunoglobulin has been associated with early death; it has been suggested that HRIG may
also pose a risk of early death in humans and should be avoided.
[33]

Regardless of treatment, symptomatic rabies is almost invariably fatal, with autonomic
dysfunction leading to cardiac arrhythmia and hypotension. Some role for combination
treatments including ribavirin, interferon, ketamine, and immunomodulatory therapies has been
proposed and may be considered in future cases under investigational protocols.
The survival of a teenaged girl from Wisconsin received substantial attention in October 2004 as
the first reported case of human survival of rabies in the absence of preceding vaccination or
postexposure prophylaxis.
[34]
Notably, she received an investigational regimen of ribavirin,
amantadine, and a ketamine-midazolaminduced coma; however, this therapy has not been
validated and has not been reproducible. Further, the bat rabies virus isolated in this case may
be less neurovirulent than canine or other variants that are responsible for most human cases of
rabies.
Reports of failures of what is commonly referred to as the Milwaukee Protocol outnumber
successes reported in the lay press, and the CDC has yet to publish information confirming
subsequent survivors. In any case, the possibility of successful treatment may be deemed by
some to be an improvement over the current standard of care. The University of Wisconsin
maintains a rabies registry tracking the use of this treatment and variations of it, and suggests
longer survival periods compared with standard therapy in European and US cases. Registry
referral information and the Milwaukee Protocol are offered as an open-source document for
humanitarian use on the University of Wisconsin Web site (Rabies Registry website).
The rarity of human rabies hinders timely testing of therapies. Immunomodulatory therapies
such as rabies immunoglobulin, rabies vaccine, and interferon have not altered outcomes in
trials.
Steroids, which are usually indicated in the treatment of local vaccine reactions or cerebral
edema, are contraindicated because of increased mortality noted in animal studies and because
they reduce the response to the vaccine.
Transfer
For a patient with an illness consistent with rabies, timely diagnostic workup is essential.
Transfer to a tertiary care center with high-level intensive care support and clinicians
knowledgeable in managing rabies is optimal whenever feasible.
Treatment List for Rabies
The list of treatments mentioned in various sources for Rabies includes the following list.
Always seek professional medical advice about any treatment or change in treatment plans.
Human rabies immunoglobulin (HRIG) shots - a form of rapid passive immunization;
used before starting rabies shots.
Rabies vaccine shots - active immunization; typically a series of 5 shots; there are
various types of rabies shots.
o Human diploid cell vaccine (HDCV)
o Rabies vaccine adsorbed (RVA)
o Purified chick embryo cell culture (PCEC)
Intensive care
Respiratory support
Cardiac support
Symptomatic and supportive treatments
See also prevention of rabies for measures to take after an animal bite or possible rabies
exposure
Behavior therapy, anti-anxiety medication
Alternative Treatments for Rabies
Alternative treatments or home remedies that have been listed as possibly helpful for Rabies
may include:
Hydrophobinum homeopathic prevention and treatment
Belladonna homeopathic prevention and treatment
Stramonium homeopathic remedy
Hyoscyamus homeopathic remedy
more treatments
List of causes of Rabies
Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying
causes of Rabies) that could possibly cause Rabies includes:
Animal bite
Raccoon bite - 44% of USA rabies cases
Skunk bite - 28.5% of USA rabies cases
Bat bite - 12.5% of USA rabies cases
Fox bite (type of Animal bite) - 5.5% of USA rabies cases
Bite of an infected animal
Aerosol through mucous membranes
Sexual relations
Kisses
Transplant surger
L-arginine was first isolated in 1886, reportedly from the extract of a lupine
( Lupinus spp.) seedling. Lupinus is a genus in the legume (Fabaceae) plant family.
Arginine is a semiessential amino acid; although the body normally makes enough of it,
supplementation with additional amounts is sometimes needed. Arginine is found in
foods containing protein.
Arginine is a chemical precursor to nitric oxide (a blood vessel-widening agent called a
vasodilator). Early evidence suggests that arginine may help treat medical conditions
that improve with increased vasodilation. These conditions include chest pain,
atherosclerosis (clogged arteries), heart disease or failure, erectile dysfunction,
intermittent claudication/peripheral vascular disease, and vascular headaches
(headache-inducing blood vessel swelling).
Arginine also triggers the body to make protein and has been studied for healing
wounds, bodybuilding, enhancing sperm production, and preventing tissue wasting in
people with critical illnesses. However, caution is warranted. Arginine use was
associated with death in certain groups of heart patients. Caution is also needed when
using arginine to treat pre-eclampsia (high blood pressure in pregnancy).
Arginine hydrochloride has high chloride content and has been used to treat metabolic
alkalosis. This use should be under the supervision of a qualified healthcare
professional.
Rabies Nursing Management
Posted on February 21, 2012 by RNspeak in Community Health Nursing with 0 Comments

Rabies is a human infection that occurs after a transdermal bite or scratch by an infected animal, like dogs and cats.
It can be transmitted when infectious material, usually saliva, comes into direct contact with a victims fresh skin
lesions. Rabies may also occur, though in very rare cases, through inhalation of virus-containing spray or through
organ transplants.


Rabies is considered to be a neglected disease, which is 100% fatal though 100% preventable. It is not among the
leading causes of mortality and morbidity in the country but it is regarded as a significant public health problem
because (1) it is one of the most acutely fatal infection and (2) it is responsible for the death of 200-300 Filipinos
annually.
Mode of transmission
When the virus first enters the body via an infected bite, it first spreads from the inoculum region to the spinal cord
and onto the brain. After replication in the brain, the virus travels outward to many locations of the body, including
the salivary glands and corneal epithelial cells. The most interesting characteristic of the rabies virus is that it infects
the brain, causing the animal to want to bite, and then concentrates itself in the salivary glands to ensure
transmission its next host.
Sign and Symptoms
Animals Human
may appear sick, crazed, or vicious (mad dog) pain, tingling, and/or itching at bite site.
may also appear overly friendly,docile or confused - nonspecific fever, chills, fatigue, muscle aches
nocturnal animals alert during the day later high fever, agitation, confusion

extreme hydrophobia and aerophobia

death during later stages
Incubation period
The usual incubation period is 2 to 8 weeks. However, It can also belong for a year it depends on the severity of the
wounds and the resistance of the host.

Period of commnunicability
The patient is commnunicable 3 to 10 days before the onset of symptoms until the entire course of illness.
Diagnosis
No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the
rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Post mortem,
the standard diagnostic technique is to detect rabies virus antigen in brain tissue by fluorescent antibody test.
Treatment
Once symptoms for rabies appear, there is no treatment. However, a vaccine can be administered after an exposure
(postexposure prophylaxis). The indication of vaccination depends on type of contact with the rabid animal.
Category of exposure to suspect rabid animal Post-exposure measures
Category I -touching or feeding animals, licks on intact skin None
Caregory II -nibbling of uncovered skin, minor scratches or
abrasions without bleeding
Immediate vaccination and local treatment of
the wound
Category III- single or multiple transdermal bites or scratches, licks
on broken skin; contamination of mucous membrane with saliva
from licks, exposures to bats.
Immediate vaccination and administration of
rabies immunoglobulin; local treatment of the
wound
Recommended Postexposure Prophylaxis Administration
A patient who is exposed and has never been vaccinated against rabies should give Intramascular (IM) of rabies
immune globulin (RIG) on day 0, give 1 mL of rabies vaccine on days 0, 3, 7, 14, and 28. If the patient have
previously vaccinated with cell culture vaccine and previously demonstrated rabies antibody he/she should receive 2
IM doses of 1 ml each,one immediately and one 3 days later.RIG should not be given.
Note: Admister IM in deltoid area in older children ,adults and in mid-lateral aspect of thigh in young children.
Never administer rabies vaccine in gluteal area this may result in inadequate immune response.Post exposure
prophylaxis dose must be given as soon as possible.
Nursing Management
Provide patient Isolation
Wash hands before and after patient contact to prevent self-contamination and spread of disease
Give emotional and spiritual support to family by helping them cope with patients symptoms and probable
death
Darken the room,provide a quite enviroment
Patient should not be bathed and must not have any running water in the room.
Continously monitor cardiac and respiratory function
Refere
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RISKS:
Rabies vaccinations may cause headaches, muscle aches, or fever. The area where the
shot was given may be painful, red, swollen, or itchy. You may get rabies even after you
have the rabies shot. Immune globulin medicine can cause pain and a fever. Bite wounds
can damage nerves and tendons in the body. Bite wounds can also cause an infection in
the area of the wound, or in the bloodstream. Without early treatment, rabies damages the
brain and other organs. You may have brain swelling, seizures, and paralysis (being unable
to move). Rabies can be life-threatening.
WHILE YOU ARE HERE:
Informed consent
is a legal document that explains the tests, treatments, or procedures that you may need.
Informed consent means you understand what will be done and can make decisions about
what you want. You give your permission when you sign the consent form. You can have
someone sign this form for you if you are not able to sign it. You have the right to
understand your medical care in words you know. Before you sign the consent form,
understand the risks and benefits of what will be done. Make sure all your questions are
answered.
Isolation:
You may be put on isolation safety measures if you have an infection or disease that may
be given to others. Caregivers and visitors may need to wear gloves, a face mask, or a
gown. Visitors should wash their hands before leaving to keep from spreading germs.
Medicines:
You may be given the following medicines:
Vaccine: A rabies vaccine is given to help your body make antibodies to fight the virus
and help prevent rabies. The vaccine may be given before caregivers know that you
have been exposed to rabies (preexposure). It also can be given when caregivers learn
that you have been exposed to rabies (postexposure).
o If you have been exposed to the rabies virus and you have not been given the
vaccine in the past, you will be given 4 different doses. These will be given on 4
different days within a 1-month period. You will also be given a shot of rabies immune
globulin.
o If you have been given the rabies vaccine in the past and have now been exposed to
the virus, you will receive 2 doses, given 3 days apart.
o If you are at risk of being exposed to rabies, you will be given 3 doses on different
days. These are given within a 1-month period.

Rabies immune globulin: If you have been exposed to rabies, you may be given
rabies immune globulin to attack the virus. This medicine will also help your immune
system fight the infection. If you have been given the rabies vaccine in the past, you will
not be given this medicine.
Anticonvulsant medicine: This medicine is given to control seizures. Take this
medicine exactly as directed.
Antiviral medicine: This is given to prevent or treat an infection caused by a germ
called a virus. Antiviral medicine may also be given to control symptoms of a viral
infection that cannot be cured.
Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
o Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your
pain does not decrease. The medicine may not work as well at controlling your pain if
you wait too long to take it.
o Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver
when you want to get out of bed or if you need help.

Sedative: This medicine is given to help you stay calm and relaxed.
Steroids: This medicine may be given to decrease inflammation.
Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus.
The Td booster may be given to adolescents and adults every 10 years or for certain
wounds and injuries.
Wound care:
If you have a bite wound, caregivers will clean it well and do other treatments if needed.
Your risk of infection and rabies decreases if your wound is cleaned soon after you are
bitten. Caregivers may close the wound using stitches.
Heart monitor:
This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's
electrical activity.
Neurologic exam:
This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show
caregivers how well your brain works after an injury or illness. Caregivers will check how
your pupils (black dots in the center of each eye) react to light. They may check your
memory and how easily you wake up. Your hand grasp and balance may also be tested.
Respiratory support:
Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should
be. You may get oxygen through a mask placed over your nose and mouth or through
small tubes placed in your nostrils. Ask your caregiver before you take off the mask or
oxygen tubing.
Ventilator: This is a machine that gives you oxygen and breathes for you when you
cannot breathe well on your own. An endotracheal (ET) tube is put into your airway
through your mouth or nose. You may need a trach if an ET tube cannot be placed. A
trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or
trach is attached to the ventilator.
Tests:
Biopsy: Your caregiver may do a skin biopsy on you. A biopsy is done by removing a
small piece of tissue and then sending it to the lab for tests. A skin sample is usually
taken from the back of the neck. A biopsy can help caregivers learn the cause of your
symptoms.
Blood tests: You may need blood taken to give caregivers information about how your
body is working. The blood may be taken from your hand, arm, or IV.
Culture: This is a test to grow and identify the germ that is causing your illness.
Samples may be taken from your saliva, tears, or fluid in the brain and spine.
Lumbar puncture: This procedure may also be called a spinal tap. During a lumbar
puncture, you will need to lie very still. Caregivers may give you medicine to make you
lose feeling in a small area of your back. Caregivers will clean this area of your back. A
needle will be put in, and fluid removed from around your spinal cord. The fluid will be
sent to a lab for tests. The tests check for infection, bleeding around your brain and
spinal cord, or other problems. Sometimes medicine may be put into your back to treat
your illness.
MRI: This scan uses powerful magnets and a computer to take pictures of your brain. It
will also take pictures of the blood vessels and structures in your head. You may be
given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye,
iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on
your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are
anxious or a
Period com
Absolutely not. If you're bitten by an animal you think has rabies for any reason, you go to the
hospital and get a proactive treatment. The incubation period of the disease is usually a few
months in humans, depending on the distance the virus must travel to reach the central nervous
system. Once the rabies virus reaches the central nervous system and symptoms begin to
show, the infection is effectively untreatable and usually fatal within days.
Dog's can be contagious for Rabies for a couple days prior to developing symptoms of Rabies.
Like I said in your other question, Rabies in dogs has been EXTENSIVELY studied...as have
cats and ferrets. Hence the 10 day quarantine/observation periods advised for these
animals...and ONLY these animals.
If the dog is still healthy 10 days after it bites you....there is no Rabies risk from that bite


Rabies is a human infection that occurs after a transdermal bite or scratch by an infected animal,
like dogs and cats. It can be transmitted when infectious material, usually saliva, comes into
direct contact with a victims fresh skin lesions.Rabies may also occur, though in very rare cases,
through inhalation of virus-containing spray or through organ transplants. Rabies is considered
to be a neglected disease, which... Etiology
Rabies is caused by various negative-sense RNA viruses of the Lyssavirus genus,
which belongs to the Rhabdoviridae family. The genus is composed of 12 recognized
species: rabies virus, image Lagos bat virus, image Mokola virus, Duvenhage virus, Aravan
virus, Irkut virus, Khujand virus, European bat lyssavirus types 1 and 2, West Caucasian
bat virus, Australian bat lyssavirus type 1 and, most recently, Shimoni bat virus. [13] A
recently discovered species has also been proposed: Ikoma virus. [14]
Rabies is usually transmitted to humans following a bite from an infected animal. Rabies
virus is the form carried by dogs and accounts for most human rabies globally. Nonbite
exposures are also possible and include being scratched, being licked over an open
wound or mucous membrane, or being exposed to infected brain tissue or CSF.
There are a few reported cases of rabies being transmitted by organ transplantation.
Pathophysiology
The incubation period is variable. It is usually 2 weeks to 3 months but with a range
from 5 days to 7 years. Shorter incubation periods are associated with severe bites and
bites to the head and face. The nicotinic acetylcholine receptor at the motor end plate
mediates virus entry to myocytes, where initial replication takes place. [11] The virus
enters the nervous system through unmyelinated sensory and motor terminals and is
transported by fast retrograde axonal transport, crossing new synapses roughly every
12 hours. Once the virus has entered the immune nervous system, it is sequestered
from the immune system and immunization will not be effective. Clinical symptoms
begin once the virus infects the spinal cord and progress rapidly as the virus spreads
through the CNS. [15] The rabies virus exits the CNS through motor, sensory, and
autonomic nerves, and replicates locally in salivary and lacrimal glands in order to be
transmitted to the next host.
Many aspects of rabies pathophysiology remain a mystery. It is unclear how rabies
causes paralysis. [16] The pathophysiologic differences between the encephalitic and
paralytic forms of rabies are unknown. The cause of death in rabies is unknown
because wild-type viruses are not cytopathic, apoptotic, or inflammatory. Atypical, less
severe forms of neurological illness are beginning to be reported, suggesting a
continuum of rabies severity. [17] [18]