Rabies (hydrophobia) - Symptoms

The symptoms of rabies are cyclical. There is an incubation period, a period of precursors (prodromal), excitation and paralysis. The duration of the incubation period of rabies is from 7 days to a year or more (usually 30-90 days), depending on the location of the bites (the greater the distance to the brain, the longer it is), their depth and extent. The shortest incubation period is typical for bites to the face, head, perineum, genitals, the longest - for single bites to the body and lower limbs.

The prodromal period of rabies (hydrophobia) lasts 1-3 days. The appearance of unpleasant sensations and pain at the site of the bite may be preceded by fever. At the same time, symptoms of rabies are noted: insomnia, depressed mood, irritability, a feeling of fear, melancholy, increased sensitivity to auditory and visual stimuli, hyperesthesia of the skin, a feeling of lack of air. Most often, an increase in emotional activity is observed lasting from several hours to several days.

The first signs of acute encephalitis are attacks of psychomotor agitation. Soon, changes in consciousness, hallucinations, aggressiveness, violence, delusional ideas, muscle spasms, and convulsions join in. The patient tries to escape, bite, and attacks with fists. Against this background, an attack of the disease occurs ("paroxysm of rabies"), accompanied by spasms of the muscles of the pharynx, larynx, and diaphragm, and breathing and swallowing may be impaired. Psychomotor agitation, hypersalivation, and vomiting are characteristic, leading to dehydration. The attacks last for several seconds or minutes, then their frequency increases, and they are provoked by an attempt to drink (hydrophobia), a breath of air (aerophobia), bright light (photophobia), or a loud sound (acousticophobia). At the height of the attack, breathing may stop. Between attacks, consciousness usually clears up. Symptoms of rabies, such as signs of impaired stem functions, are soon added to the symptoms of encephalitis. Damage to the cranial nerves leads to diplopia, facial muscle paresis, optic neuritis, and swallowing disorders. Drooling combined with dysphagia leads to foaming at the mouth, which is very typical for patients with rabies. Tachycardia and hyperthermia are observed.

The next stage of rabies (hydrophobia) is paralytic. Convulsions and agitation cease, consciousness clears up. Against the background of an imaginary improvement of the condition, death occurs from paralysis of the respiratory or vasomotor center. Various variants of the course of the disease are possible: the absence of a prodromal period or the development of "silent" rabies (often after bat bites) - the development of ascending paralysis, reminiscent of Guillain-Barré syndrome, is typical.

The outcome of rabies (hydrophobia) is the death of the patient. In the absence of intensive care (IVL), half of the patients die 4 days after the first symptoms of rabies appear, and all patients die within 20 days. If IVL is used, late complications may develop: antidiuretic hormone hypersecretion syndrome, diabetes insipidus, hemodynamic instability, arrhythmia, adult respiratory distress syndrome, gastrointestinal bleeding, thrombocytopenia, etc.

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