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History: Suspicion of rabies is clear when a history of an animal bite is given; however, because a history of animal bite is obtained in less than one half of US cases, diagnosis is problematic. Presentation of a patient in the rabies prodromal stage without a clear exposure history is so nonspecific and rare that making the diagnosis in the ED is essentially impossible. Rabies progresses over 7-14 days, and the mean time between initial presentation and death is 16.2 days.
Patients have presented to EDs with nonspecific fevers and pharyngitis.
Most prodromes last from 2-10 days.
Initial symptoms of pain or paresthesias at the site of bite or scratch begin during the prodrome. These are the only symptoms that specifically may raise the red flag of a rabies diagnosis.
Fever, headache, and anorexia also may be present.
Neurologic stage (2-7 days)
Mental status changes
Disseminated intravascular coagulation (DIC)
High fevers with rapidly progressive encephalitis