Most rabies cases end terminally within 14 days of infection. The time between the bite and the first visible symptom depends where the victim was bitten. The further the bite is away from the central nervous system, the longer it takes for the first symptoms to appear. We differentiate between furious (excitative) rabies and dumb (paralytic) rabies, depending on whether the clinical presentation is dominated by a phase of hyperactivity or only by signs of paralysis.
The disease progresses in three classic stages:
Humans: unspecific symptoms, such as signs of an influenza-like infection, aches, itching or parasthesia (neuropathic pains, e.g. tingling or burning sensations) around the area of the bite.
Animals: lethargy, fever, nausea, loss of appetite, vomiting, hydrophobia
Humans: about 80% of patients develop this classic form of rabies (“furious rabies”). It is characterised by episodes of confusion, severe agitation and aggressiveness, alternating with periods of full consciousness. Additionally, fever, increased salivation, perspiration, widened pupils and goose bumps have also been described as symptoms. Cramps are rare, but may occur at a more progressed stage of the disease. The majority of patients develop hydrophobia, the most characteristic symptom of rabies. The disease will finally cause pareses, coma and multiple organ failure.
Animals: phases of severe agitation, hyperactivity, aggressiveness, salivation
Humans: in the paralytic form of rabies (“dumb rabies”, ca. 20 % of all cases) symptoms are the early onset of paresis and, later, pain, sensitivity disorders and vegetative dystonia. Hydrophobia is a less common symptom in this form, but may still occur. Eventually, the disease ends fatally through the complete paralysis of the respiratory muscles.
Animals: paralysis, sensitivity disorders, coma.