Fast Five Quiz: Dog and Cat Bites

Richard H. Sinert, DO

Disclosures

July 09, 2020

Most cases of human rabies acquired from dogs manifest as "furious rabies." Patients develop agitation, hyperactivity, restlessness, thrashing, biting, confusion, or hallucinations. After several hours to days, this becomes episodic and interspersed with calm, cooperative, lucid periods. Furious episodes last less than 5 minutes. Episodes may be triggered by visual, auditory, or tactile stimuli or may be spontaneous. Seizures may occur. This phase may end in cardiorespiratory arrest or may progress to paralysis.

A minority of patients develop paralytic rabies, also known as "dumb rabies" or "apathetic rabies," because the patient is relatively quiet compared with a person with the furious form. Paralysis occurs from the outset, and fever and headache are prominent. Paralytic rabies may initially mimic Guillain-Barré syndrome (GBS), with ascending lower motor-neuron weakness unpreceded by classic "mad" signs, and rabies should be considered in the differential diagnosis of GBS.

According to the World Health Organization (WHO), dogs are the main source of human rabies deaths, contributing to as many as 99% of all cases. The WHO also states that the incubation period for rabies is 2-3 months but can vary from 1 week to 1 year, depending on such aspects as the location of virus entry and the viral load.

Recommendations from the Centers for Disease Control and Prevention (CDC) state that if a dog or cat appeared healthy at the time of the bite, and if the animal can be held in quarantine for 10 days, no antirabies prophylaxis is needed.

Read more about rabies.

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