First Aid Bites & Stings Rabies Guide Rabies Guide Overview Symptoms Causes Diagnosis Treatment Symptoms of Rabies By Rod Brouhard, EMT-P Rod Brouhard, EMT-P Facebook LinkedIn Twitter Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Learn about our editorial process Updated on August 23, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Latesha Elopre, MD, MSPH Medically reviewed by Latesha Elopre, MD, MSPH LinkedIn Latesha Elopre, MD, is a board-certified internist specializing in HIV. She is an assistant professor of infectious diseases at the University of Alabama at Birmingham. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Incubation Period Prodromal Period Acute Neurologic Period When to See a Doctor Frequently Asked Questions Next in Rabies Guide Rabies: Causes and Risk Factors Despite being rare in the United States, rabies remains a frightening prospect due to the speed neurological symptoms can develop and progress. Early infection may be marked only by a mild fever and headache. Symptoms developing after the incubation period (30 to 90 days) will invariably be severe and include confusion, excessive salivation, seizures, paralysis, delirium, and coma. Once symptoms appear, death is, sadly, almost inevitable. This type of virus, known the lyssavirus, moves through the network of nerve cells, causing progressive symptoms as it gradually infiltrates the brain and central nervous system. That's why, unlike some infectious diseases, you cannot wait for signs of the illness to appear. You must seek treatment the moment you come you are bitten or scratched by an animal that has or is suspected to have rabies. The symptoms of rabies can be characterized by the stages of infection, broadly described as the incubation period, the prodromal period, the acute neurologic period, and coma preceding death. © Verywell, 2018 Incubation Period The incubation period is the time between exposure to the virus and the first appearance of symptoms. The period can run anywhere 30 to 90 days on average but may be shorter or longer based on the host and viral factors. Symptoms of rabies during the incubation period may include: Fever A headache Tingling or burning sensation at the site of the exposure (known as paresthesia) Prodromal Period The prodromal period is described by the first appearance of symptoms. This is when the virus first enters the central nervous system and begins to cause damage. The prodromal phase tends to run from two to 10 days on average and may cause such symptoms as: Fatigue A general feeling of unwellness (malaise) Loss of appetite (anorexia) A sore, swollen throat (pharyngitis) Nausea Vomiting Diarrhea Agitation Insomnia Anxiety and depression Acute Neurologic Period The acute neurologic period lasts anywhere from two to ten days and will almost invariably end in death. The types and characteristics of symptoms can vary, depending largely on how severe or mild the initial exposure was. Furious rabies is the type most people with experience. As its name suggests, this form of rabies is characterized by violent physical and neurologic symptoms. Symptoms may come and go, and will often be interspersed with moments of calm and lucidity. Death will most often be caused by cardio-respiratory arrest. Paralytic rabies affects up to 20 percent of people and will cause muscles to gradually weaken, starting from the site of the exposure and expanding outward. Paralysis and death will eventually ensue (usually by respiratory failure). Most paralytic cases are believed to be caused by a minor injury, such as a nip, that has gone unnoticed. Atypical rabies is a type most often associated with bat bites. It may involve symptoms from both furious and paralytic forms of the disease. The variations in symptoms and severity can often make it hard to recognize a case as rabies. Symptoms of rabies occurring during the acute neurologic period may include: Hyperactivity Excessive salivation Hydrophobia (a distressing symptom characterized by an unquenchable thirst, an inability to swallow, and panic when presented with fluids to drink) Priapism (persistent and painful erection of the penis) Extreme sensitivity to light (photophobia) Paranoia Confusion and incoherence Aggression (including thrashing and biting) Hallucinations Seizures Partial paralysis Delirium These symptoms will soon to lead to a coma as the rabies infection causes massive brain inflammation. Without intensive supportive care, death will usually occur within hours or days. When to See a Doctor Once rabies symptoms begin to appear, the infection is almost always fatal. To this end, you need to seek care the moment you are bitten by a wild animal—or even a domestic one. Start by washing the wound thoroughly with soap and warm water. While a doctor should be seen as a matter of urgency, the condition is not considered to be a medical emergency at this stage. It is simply important to see a physician, ideally on the same day, and to provide as much information as you can about the attack. Even if you've been previously vaccinated for rabies, you should still have your wound looked at. Rabies Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. If the animal has been captured (or the suspected pet quarantined), tests can be performed to determine whether it has rabies. But, even then, treatment wouldn't necessarily be delayed pending the results. This is because the only sure way to confirm rabies is to euthanize the animal and obtain two tissue samples from the brain. Clearly, with a domestic animal, this may be less of an option if the symptoms are vague, non-specific, or nonexistent. Whatever the circumstance, if there is a genuine suspicion of exposure, treatment should be started without delay. On the other hand, if you have been scratched by a suspicious animal or have come into contact with body fluids from a sick or dead animal, you should still see a doctor if only for your peace of mind. This is especially true if you live in an area where animal rabies has been identified. While rabies can only be transmitted through saliva or brain/nerve tissues, any potential exposure, however small, should be taken seriously. If anything, it may provide you the impetus to get the rabies vaccine and reduce your future risk. Frequently Asked Questions Can rabies be cured after initial symptoms appear? Once clinical symptoms start, rabies is almost always fatal, which is why it is important to get vaccinated as soon as you think you are exposed, and always vaccinate household pets. What are the signs of a rabid animal? Rabid animals may shows signs of fear, aggression, salivating, difficulty swallowing, paralysis, and seizures. Animals may also exhibit uncharacteristic behaviors such as wandering around in daylight hours when the animal is typically nocturnal. How quickly do you need to get a rabies vaccine after a bite to avoid being infected? Get the rabies shot as soon as possible, but ideally within 24-48 hours of exposure. Additional doses will also be needed on days 3, 7, and 14. Rabies: Causes and Risk Factors Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Rupprecht CE. Rhabdoviruses: Rabies Virus. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston. Chapter 61. Yousaf, M.; Qasim, M.; Zia, S. et al. Rabies molecular virology, diagnosis, prevention, and treatment. Virol J. 2012; 9: 50. doi:10.1186/1743-422X-9-50 Rupprecht CE. Rhabdoviruses: Rabies Virus. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston. World Health Organization. Rabies. Mahadevan A, Suja MS, Mani RS, Shankar SK. Perspectives in diagnosis and treatment of rabies viral encephalitis: Insights from pathogenesis. Neurotherapeutics. 2016;13(3):477-92. doi:10.1007/s13311-016-0452-4 American Veterinary Medical Association. Rabies and your pet. Immunization Action Coalition. Rabies questions and answers. Additional Reading Centers for Disease Control and Prevention. Rabies: When should I seek medical attention?. Centers for Disease Control and Prevention. Human Rabies.