4. Clinical Presentation

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Prodromal Syndrome: Pain, Itching, Tingling sensation and numbness at the site of wound in association with fever, malaise, headache, nausea, vomiting and myalgia

Classic Rabies (furious form) Manifestations:

Furious rabies accounts for approximately 80% of the total number of human cases; manifesting as signs of-

  • Delirium with alternating periods of calm i.e., Altered Behavior, Hallucinations, Incoordination
  • Aerophobia
  • Hydrophobia during attempts at drinking due to extremely painful laryngeal spasms
  • Photophobia
  • Excessive salivation, Aggression, Hyperactivity periods of agitation alternating with lucidity
  • After a few days, the infection invariably leads to coma and death by cardio-respiratory arrest.9

Paralytic or Dumb Form (less common):

An acute, ascending paralysis resembling Guillain-Barre syndrome predominates with initially relative sparing higher cortical functions.9

Paralytic (or dumb) rabies accounts for approximately 20% of the total number of human cases.

This form of rabies runs a less dramatic but longer course than the furious form. There is flaccid muscle weakness in the early onset of infection, starting at the bite or scratch site, followed by gradual paralysis. The development of coma generally precedes death by respiratory failure. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease.

Both forms progress relentlessly to coma, autonomic nervous system dysfunction, and death despite intensive support.

Fatality after the onset of manifestation is 100%.