Rabies is a viral brain infection spread through the saliva of infected animals, mostly bats, raccoons, skunks and foxes in the US, and it is almost always fatal once symptoms appear. Prompt wound care and post-exposure prophylaxis after a risky bite or scratch prevents the disease.
Key symptoms
- Bite or scratch from a wild animal or unvaccinated pet
- Bat contact, including a bat found in the room of a sleeping person
- Tingling or pain at the wound site (early sign of disease)
- Fever, agitation, fear of water or trouble swallowing (late disease)
What you find on exam
- Wound location, depth and number of bites
- Neurologic exam
- Signs of wound infection
- Tetanus vaccine status
Tests
- No test rules out rabies in the exposed person
- Brain testing of the animal if it can be safely captured
- 10-day observation of a healthy dog, cat or ferret
- Call the local health department for risk assessment
Treatment basics
- Wash the wound with soap and water for 15 minutes
- Rabies immune globulin 20 IU/kg, as much as possible into and around the wound
- Rabies vaccine on days 0, 3, 7 and 14 (add day 28 if immunocompromised)
- Previously vaccinated people: vaccine on days 0 and 3 only, no immune globulin
- Tetanus booster and antibiotics for high-risk wounds
Red flags
- Bite to the head, neck or hands
- Bat exposure in a sleeping person or young child
- Any neurologic symptoms after an exposure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.