From the Guidelines
Pathognomonic signs of rabies include hydrophobia, aerophobia, and hypersalivation, which are critical to identify for prompt medical intervention to prevent mortality. These signs are a result of the rabies virus affecting the central nervous system, particularly the limbic system, brainstem, and medulla 1.
Key Signs and Symptoms
- Hydrophobia: painful pharyngeal spasms and terror when attempting to drink water or even seeing or hearing water
- Aerophobia: similar spasms triggered by air currents across the face
- Hypersalivation: occurs as the virus affects salivary gland function and patients cannot swallow their saliva due to pharyngeal spasms Other characteristic signs include agitation, confusion, hallucinations, and autonomic instability, which typically appear during the encephalitic (furious) phase of rabies 1.
Clinical Management
The appearance of these pathognomonic signs highlights the critical importance of post-exposure prophylaxis with rabies immune globulin and vaccination immediately after potential exposure, as once these signs appear, rabies is almost invariably fatal 1.
Prevention and Prognosis
Prevention of rabies through prompt wound cleansing, passive vaccination with HRIG, and vaccination with cell culture rabies vaccines is essential, as treatment of clinical rabies remains an extreme challenge 1. Rapid antemortem diagnosis is a priority, and primary health considerations should focus on comfort care and adequate sedation of the patient in an appropriate medical facility 1.
From the Research
Pathomnemonic Signs of Rabies
There are no direct mentions of pathomnemonic signs of rabies in the provided studies 2, 3, 4, 5, 6. However, some studies describe the symptoms and characteristics of rabies:
- Hyperexcitability, autonomic dysfunction, hydrophobia, and aerophobia are characteristic of encephalitic rabies, which accounts for 80% of cases 3
- The paralytic form is characterized by flaccid paralysis in the bitten limb, which ascends symmetrically or asymmetrically 3
- Once symptoms develop, the disease is invariably fatal 3
Prevention and Treatment
The studies focus on the prevention and treatment of rabies, including:
- Post-exposure prophylaxis (PEP) consisting of wound cleansing, immunization with modern cell culture vaccine, and administration of rabies immune globulin 2, 3, 4, 5, 6
- Preexposure vaccination with modern cell culture vaccine for people at high risk of exposure to rabies 3
- The importance of proper administration of rabies biologicals and clear doctor-patient communication 2
- The use of human rabies immunoglobulin (HRIG) in post-exposure prophylaxis for category III animal exposures 6