Clinical features

After the prodromal period, patients develop objective signs of CNS disease:

• hyperactivity
  • classically seen intermittently, short periods (1-5 minutes) of agitation, thrashing, running, or other bizarre behaviour alternate with periods of calmness where the patient is cooperative and oriented (maybe anxious)
  • hyperactivity episodes may occur spontaneously or precipitated by tactile, auditory, visual or other stumuli.
• disorientation
• hallucinations
• seizures
• bizarre behaviour
• hydrophobia or aerophobia
  • attempt to drink water results in severe spasms of the pharynx and larynx which may lead to choking, gagging and fear. Hence these symptoms may be precipitated when the patient sees water or has air blown on the face.
• nuchal stiffness
• fever
• fasciculations of the muscles
• hypersalivation
• paralysis

Clinical examination reveals hypereflexia, spasticity, and evidence of sympathetic overactivity indicated by pupillary dilatation and diaphoresis.

There is development of convulsions, respiratory paralysis and cardiac arrhythmias. Death usually occurs in 10-14 days from onset of neurological dysfunction if no intensive care is instituted.

Reference:

• (1) Walsh and Hoyt's Clinical Neuro Ophthalmology: Volume Three, Sixth edition.
• (2) World Health Organization (WHO). Rabies