Rabies (hydrophobia): symptoms
Last reviewed: 23.04.2024
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Symptoms of rabies are cyclical. Distinguish the incubation period, the period of harbingers (prodromal), excitation and paralysis. The duration of the incubation period of rabies - from 7 days to a year or more (more often 30-90 days), depends on the location of bites (the greater the distance to the brain, the longer it is), their depths and vastness. The shortest incubation period is typical for bites in the face, head, perineum, genitalia, the longest - for single bites in the trunk and lower limbs.
The prodromal period of rabies (hydrophobia) lasts 1-3 days. The appearance of unpleasant sensations and pain at the site of a bite may be preceded by fever. Simultaneously, symptoms of rabies are noted: insomnia, depressed mood, irritability, fear, longing, increased sensitivity to auditory and visual stimuli, hyperesthesia of the skin, a sense of lack of air. The most often observed increase in emotional activity lasting from several hours to several days.
The first signs of acute encephalitis are attacks of psychomotor agitation. Soon, a change in consciousness, hallucinations, aggressiveness, rampage, delusions, muscle spasms, convulsions join. The patient tries to escape, bite, attack with fists. Against this background, there is an attack of the disease ("paroxysm of rabies"), accompanied by cramps in the muscles of the pharynx, larynx, diaphragm, possibly breathing and swallowing. Characterized by psychomotor agitation, hypersalivation, vomiting, which leads to dehydration. Attacks last for several seconds or minutes, in the future their frequency increases, they are provoked by their attempt to drink (hydrophobia), air blow (aerophobia), bright light (photophobia) or loud sound (acoustic phobia). At the height of the attack, respiration may stop. Between attacks, consciousness, as a rule, becomes clear. Symptoms of encephalitis are soon joined by such symptoms of rabies as signs of impairment of stem functions. The defeat of the cranial nerves leads to diplopia, paresis of the facial muscles, neuritis of the optic nerve, impaired swallowing. Salivation in combination with dysphagia leads to the appearance of foam from the mouth, which is very typical for patients with rabies. There is tachycardia, hyperthermia.
The next stage of rabies (hydrophobia) is paralytic. Cramps and excitement stop, consciousness clears up. Against the background of an alleged improvement in the state, death from paralysis of the respiratory or vasomotor center occurs. There are various variants of the course of the disease: the absence of a prodromal period or the development of "silent" rabies (often after bites of bats) is characterized by the development of ascending paralysis resembling the Guillain-Barre syndrome.
The outcome of rabies (hydrophobia) is the death of the patient. In the absence of intensive therapy (IVL), after 4 days after the first symptoms of rabies, half of the patients die, after 20 days - all the diseased. If IVL is performed, late complications may develop: hypersecretion syndrome of antidiuretic hormone, diabetes insipidus, hemodynamic instability, arrhythmias, adult respiratory distress syndrome, gastrointestinal bleeding, thrombocytopenia, etc.
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