Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 32-03: Other Neurotropic Viruses + Key Features Download Section PDF Listen +++ ++ A rhabdovirus infection causing encephalitis, transmitted by infected saliva after an animal bite Bats, raccoons, and skunks are most common vectors in the United States Other rabid animals include foxes, cats, cattle, and dogs Human cases rare in the United States Incubation period of 3–7 weeks, proportional to distance from wound to CNS Usually fatal unless patients receive postexposure prophylaxis + Clinical Findings Download Section PDF Listen +++ ++ Prodrome includes pain at site of bite, fever, nausea CNS symptoms (encephalitis or paralysis) begin about 10 days later Encephalitis: delirium and extremely painful laryngeal spasms that lead to hydrophobia Paralysis: less common; ascending paralysis resembles Guillain-Barré syndrome Both encephalitic and paralytic forms progress to coma, autonomic dysfunction, death + Diagnosis Download Section PDF Listen +++ ++ Diagnosis suggested by history of animal bite, initial viral prodrome followed by CNS symptoms Diagnosis confirmed with fluorescent antibody testing of sacrificed animal brain Skin biopsy from the patient's posterior neck has ∼80% sensitivity Quantitative reverse transcriptase PCR (qRT-PCR), nucleic acid sequence-based amplification, direct rapid immunohistochemical test (DRIT) and viral isolation from the cerebrospinal fluid or saliva are advocated as definitive diagnostic assays + Treatment Download Section PDF Listen +++ ++ Animal bite wounds should not be sutured Local wound cleansing, débridement, and flushes are useful Treatment includes both passive antibody and vaccination Single case report of treatment success with ribavirin, amantadine, plus midazolam A combination of rabies vaccine, rabies immune globulin, monoclonal antibodies (investigational), ribavirin, interferon-α, and amantadine may be helpful For suspected cases, use of postexposure immunization should be based on clinical guidelines, and on recommendations of local health officials Prevention Immunization of household dogs Avoidance of animals associated with rabies