rabies; hydrophobia

Introduction

also see rabies virus

Etiology

• rabies virus

Epidemiology

• transmission can occur through the saliva of animals
• animal hosts:
  • raccoons
  • foxes
  • coyotes
  • bats
  • skunks
• 89 cases of human rabies from 1960-2018 in the U.S
  • 70% transmitted via bats
  • remainder caused by dog bite
• only 50% of patients with rabies have known exposure; thus diagnosis should be considered in any patient with encephalitis
• case report of rabies from organ transplantation
• outbreak among ferret-badgers 2012, Taiwan

Pathology

• retrograde axonal transport of the rabies virus to the CNS resulting in viral encephalitis
• putative receptor: acetylcholine receptor (muscarinic receptor)
• from the CNS, the virus further spreads to other organs; the salivary glands receive high concentrations of the virus, thus allowing for transmission of rabies virus through saliva
• fatality can occur within anywhere from 2 days to 5 years from the time of initial infection

Laboratory

• see rabies virus & ARUP consult

Complications

• usually, but not always fatal

Management

• prophylaxis after animal bite
  • two shots given as soon as possible after exposure (day 0)
    • one of rabies vaccine &
    • one of rabies immune globulin
      • infiltrate as much of the dose as feasible in & around the wound
  • 3 additional rabies vaccine shots should be administered on days 3, 7, & 14
  • if rabies immune globulin is not given on day 0, it should be given by day 7
  • immunocompromised patients should receive 4 rabies vaccine shots, on days 0, 3, 7 & 14
  • persons previously immunized for rabies, should receive 2 rabies vaccine shots on days 0 & 3
  • rabies vaccine shots may be delivered to the outer aspect of the thigh in younger children & to the deltoid in older children & adults; the gluteal region should never be used

More general terms

• viral infection
• central nervous system (CNS) infection

Additional terms

• rabies virus

Patient information

rabies patient information