What are the manifestations of rabies in different periods?

If you are bitten or scratched by a dog, you should go to the hospital for rabies vaccine in time, so as not to delay the treatment time and cause irreversible consequences.

Rabies has three stages: initial stage, manic stage and paralytic stage.

The performance of each stage is different, and corresponding prevention and treatment measures need to be done.

1. Pre-morbidity

Early symptoms of rabies include anxiety, headache, etc. There may also be symptoms such as vomiting, nausea, elevated body temperature, fatigue, loss of appetite, and lack of energy.

Symptoms include redness, tingling, or tingling at the bite or scratch site, and a feeling of pressure in the throat area.

In addition, discomfort and difficulty in swallowing may occur.

Usually this early stage lasts about two days, but some people may have an incubation period of up to seven days.

2. Manic period

Rabies patients will have obvious symptoms of hyperactivity during the manic stage, will have a sense of fear of water, and often have symptoms such as mania and drooling.

It's important to note that these symptoms only appear in people with rabies.

Patients experience severe throat spasms when drinking water, causing difficulty and distress in breathing.

After the disease progresses, seeing or hearing the sound of water will aggravate the symptoms, and the patient's pupils will dilate.

In the early stages of the disease, patients are clear-headed, and in the later stages, patients will experience symptoms such as drooling, sweating, mania and dehydration for two consecutive days.

3. Paralysis period

When the paralysis phase occurs, the condition appears to subside, and the person becomes calmer, has less spasticity, and may be able to eat.

This situation is sometimes described as "returning to the light", but it should be noted that after eighteen hours, the patient may experience nerve paralysis again, and even cause life-threatening.

Even if you are bitten by rabies, there is no need to panic. As long as you seek medical treatment and get rabies vaccine in time, you can avoid problems, although this infectious disease is extremely harmful.

About "What are the manifestations of rabies in different periods?"The editor also compiled the following content for you, which may also be helpful to you:

Rabies is divided into three phases: 1. Prodromal period: lasts 1-3 days, the virus reproduces in the body, but there are no obvious symptoms.

Patients may have non-specific symptoms such as fever, malaise, headache, and muscle pain.

2. Congestive period: lasts for 1-7 days, the virus begins to attack the central nervous system, and typical neurological symptoms appear, such as hydrophobia (reflexive panic and pain to the sound of water, water drinks, etc., which cannot be controlled by oneself), pharyngeal muscle Convulsions, difficulty swallowing, etc., accompanied by signs of anxiety, insomnia, hallucinations, and violent tendencies.

3. Ulcer stage: Lasts for 3-5 days, the condition worsens and manifests as coma, difficulty in breathing, accumulation of lung fluid, and eventually death due to heart and respiratory system failure.

Wang Chuanlin Chief Physician Peking University People's Hospital Medical Code Expert Group

If you are bitten or scratched by a dog, you must go to the hospital for rabies vaccine in time, so as not to delay the treatment time and cause irreparable effects. Rabies also has a development process, which is the initial stage of onset, the manic stage, and the paralyzed stage , So, what are the manifestations of rabies in different periods?

1. Pre-morbidity

Before the onset of rabies, there will be anxiety, headache, etc., and there will be vomiting, nausea, accompanied by a rise in body temperature, physical fatigue, inability to eat, lack of energy and other symptoms, and there will be bites or scratches. Redness, swelling, tingling, and numbness will also be accompanied by a sense of pressure in the throat, and complex symptoms will gradually appear. It is uncomfortable to swallow and it is difficult to swallow. Normally, it will take two days at this stage Left and right, but there are exceptions to everything. Some people have a relatively long incubation period, which may reach seven days!

2. Manic period

Mania comes from the period when the sick person will have an obvious excitement, the sick person will be afraid of water, mania from time to time, and drooling will happen. It should be noted that these symptoms are only rabies It will only happen to the patient. When the patient drinks water, there will be a very severe spasm in the throat. The patient will naturally have difficulty breathing, which is very painful, and the hair will be more severe in the later stage. What makes fat full forehead burn is that this situation will occur when seeing water or hearing the sound of water, and even the above situation will be exacerbated. The patient will have dilated pupils. Patients with early symptoms are conscious, but when Later, the patients in Rougen Province transferred to Zhansong Yannan for two days were drooling, sweating, manic, and dehydration appeared continuously!

3. Paralysis period

The situation during the paralysis period is a bit like a flashback. It becomes quieter, the spasms are less, you can eat, and there is a false impression of improvement, but after 18 hours, the nerve paralysis comes from, and then it is fatal!

Although rabies is a very harmful infectious disease, if you are bitten, don’t panic, seek medical treatment in time, and get rabies vaccine, and there will be no problem!

What are the characteristics of rabies?

The early symptoms of rabies can generally be divided into the incubation period or the clinical manifestations of the pre-zone period, mainly manifested as headache or anxiety.

1. Incubation period: During the incubation period, there may be no obvious symptoms, and the incubation period is generally about one month to three months.

2. Prozone stage: In the prozone stage, it may cause anorexia and physical fatigue accompanied by atypical symptoms such as headache and fever. With the disease, rabies is also called hydrophobia. The symptoms are characterized by unique fear of water, wind, Fear, restlessness, spasms of the pharyngeal muscles, and progressive paralysis are the hallmarks. The typical clinical manifestations of rabies are divided into three phases:

The first stage is the prodromal stage, manifested as low-grade fever, fatigue, headache, nausea, and general malaise, followed by fear, restlessness, insomnia, sensitivity to sound, light, wind and other stimuli, and throat tightness, which is more diagnostic in the early stage Symptoms are itching, pain, numbness and abnormal sensation of ants walking on the healed wound.

The second stage is the exciting stage, that is, the period of typical manifestations of rabies, manifested as high excitement, fear, fear of water and wind. Although a typical patient is very thirsty, he dare not drink water. When seeing water, hearing the sound of water, drinking water or just mentioning the word drinking water, it will cause severe spasm of the throat muscles. Causes spasms of the pharyngeal muscles.

The third stage is the paralysis stage. The patient's muscle spasm gradually stops, and then enters general paralysis, from tranquility to coma, and finally dies. Unreasonable fear and anxiety, accompanied by agitation and insomnia, may also cause depression in some patients.

Rabies is usually caused by rabies virus infection and is generally relatively serious. Therefore, after being bitten by cats and dogs and other animals, rabies vaccination is required.

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What are the symptoms of rabies

　　what is rabies

　　Rabies is an acute infectious disease caused by rabies virus. It can be zoonotic. It mainly occurs in some carnivorous animals, such as dogs, wolves, cats, etc., and the most common ones are dogs, cats, wolves and other animals in daily life. It is difficult to come into contact with it, and dogs and cats have become pets that people like to keep. Therefore, dogs and cats have become the main infectors of rabies, and most people are infected by being bitten by sick dogs or sick cats. Therefore, the best way to prevent rabies now is to make sure that the rabies vaccine is given immediately after being bitten. As long as the rabies vaccine is given, 90% of the occurrence of rabies can be controlled.

　　Symptoms of rabies

　　1. There is often a short prodromal period before the onset of rabies, which lasts for 1 to 4 days. The main symptoms are moderate fever, general feeling of discomfort, loss of appetite or even disappearance, accompanied by headache and nausea. Symptoms are similar to those of a cold and, therefore, are easily overlooked.

　　2. After the prodromal period, you will enter the nervous system symptom period. This symptom will appear in 2 to 20 days. The main manifestations are increased irritability and a strong sense of oppression, accompanied by chest pain and airflow terror In severe cases, when the wind blows on the face, it will cause spasm of the throat muscles, which will affect breathing and eating. This is one of the very typical symptoms of rabies. Favorable for clinical judgment.

　　3. Local symptoms. There will be pain in the wound site bitten by a sick dog, and there may also be abnormal sensations of numbness and itching. The hands, feet and limbs seem to have ants crawling, which is very painful. There are also patients with increased irritability to various lights, noises and sensory stimuli at the same time, unwilling to see light or be touched, and once stimulated, the facial expression will be very fearful and terrifying , This is because the virus invades the nerves, showing increased muscle tone and facial muscle spasms.

　　4. Symptoms of impaired sympathetic nervous system disease. When the sympathetic nerve is damaged, the patient will have symptoms such as sweating, salivation, mania, etc., and also show anxiety, spasmodic and painful muscle contraction, and most people will cause muscle spasms in the throat and other parts when swallowing, so they are afraid to drink water , so it is also called hydrophobia.

　　Checklist for rabies

　　1. Blood, urine and cerebrospinal fluid examination

　　The total number of peripheral blood leukocytes ranges from (12 to 30)×109/L, and neutrophils generally account for more than 80%. Urine routine examination can reveal mild proteinuria, with occasional hyaline casts, and the pressure of cerebrospinal fluid can be slightly increased. Slightly increased, generally no more than 200×106/L, mainly lymphocytes, increased protein, up to 2.0g/L or more, sugar and chloride normal.

　　2. Virus Isolation

　　Saliva and cerebrospinal fluid are commonly used to isolate viruses, and the isolation rate of saliva is relatively high.

　　3. Antigen check

　　Immunofluorescence using skin or brain biopsy.

　　4. Nucleic acid assay

　　RNA was measured by PCR method, and the positive rate of saliva, cerebrospinal fluid, or skin tissue specimens with hair follicles at the back of the neck was higher.

　　5. Animal Inoculation

　　After the specimens were inoculated into mice, the brain tissue was taken for immunofluorescence test to detect pathogens, and pathological sections were used to check Negri bodies.

　　6. Antibody check

What are the symptoms of rabies?

Rabies is a zoonotic acute infectious disease of the central nervous system caused by rabies virus. Due to the extremely high and sudden fatality rate, many people will "turn pale" when they talk about rabies, and it can even be said to be terrified.

So what are the clinical manifestations of rabies? In fact, generally speaking, the general typical clinical manifestations after getting rabies are divided into three periods, namely: the incubation period, the prodromal period, and the excited period. Next, the editor introduces these three periods in turn.

01. Incubation period

Patients in the incubation period do not have any obvious clinical manifestations, and the patients are not aware of the existence of rabies, let alone know that they have got rabies. Under normal circumstances, the incubation period is maintained between 4 and 6 weeks. However, due to the different physique of each person, the incubation period of rabies may also vary from a few days to a few years, which varies from person to person.

02. Prodromal period

During the prodromal period, the patient will have a series of clinical manifestations, such as feeling uncomfortable, lack of strength, tiredness, pain at the bitten site, and accompanied by symptoms such as fever. This usually occurs within 2 to 10 days. between. During this period, we must pay close attention to treatment, otherwise it will only make the situation worse and worse.

03. Exciting period

When the exciting period is reached, the patient's condition is already very bad. Breathing will become very weak and irregular, and a series of symptoms such as hydrophobia, vomiting, nervousness, and hallucinations will appear at the same time. Such a situation usually lasts between 6 and 18 hours, which is relatively short.

The incubation period of rabies is relatively long, but once an attack occurs, death usually occurs between 7 and 10 days. The cause of death was basically asphyxia due to respiratory failure or spasm of the pharyngeal muscles. Although the fatality rate of rabies is very high, even close to 100%, rabies is preventable.

First of all, we should learn to control the source of infection, that is, to strengthen the management of native dogs in our hometown or pet dogs in the city. When going out to walk the dog, we must remember to tie the rope and vaccinate the dog at the same time; secondly, when we are bitten by animals, we must deal with them in time to avoid wound infection, which will eventually lead to rabies; at the same time, we must Do a good job of vaccination. After being bitten, a rabies vaccine needs to be vaccinated within 24 hours to reduce the risk of disease.

The source of rabies infection is all animals with rabies, mainly dogs, followed by cats, cows, pigs, horses and other livestock. Therefore, we must pay special attention in life. When bitten by animals, we need to seek medical treatment in time, so as not to delay the best treatment time.

What are the manifestations of rabies?

The clinical manifestations of rabies can be divided into four stages. Incubation period: (about 1-3 months on average), the infected person does not have any symptoms during the incubation period. Prodromal period: The infected person begins to have symptoms such as general malaise, fever, fatigue, restlessness, pain at the bitten site, and paresthesia. Exciting period: various symptoms of the patient reach their peak, and symptoms such as nervousness, general spasm, hallucinations, delirium, fear of light, sound, water, and wind appear. Therefore, rabies is also known as hydrophobia, and patients often suffocate due to spasms in the throat died.. Coma stage: If the patient survives the exciting stage, he will enter the coma stage. In this stage, the patient is in a deep coma, but the various symptoms of rabies are no longer obvious. Most of the patients in this stage eventually die of exhaustion. In the early stage of rabies, patients often have symptoms such as low-grade fever, headache, fatigue, general malaise, nausea, irritability, insomnia, fear and restlessness. Patients become extremely sensitive to stimuli such as sound, light or wind, and immediately feel tightness in the throat when slightly stimulated. . Around the healed wound and its innervated area, there are also numbness, itching pain and abnormal sensation of ants walking. After 2-3 days, the condition enters the exciting stage. The patient is highly excited, with a prominent expression of extreme terror, fear of water and wind, and when encountering sound, light, wind, etc., the muscles of the throat will have severe spasms. Although the patient is thirsty, he does not dare to drink water, and even when he hears the sound of running water or someone mentions water, he will also experience throat spasm. In severe cases, the patient also has painful convulsions all over the body, resulting in difficulty breathing. Most rabies patients are conscious; however, some patients have mental disorders. After about two or three days of excitement, the patient becomes quiet, but then he becomes paralyzed, his respiratory and circulatory systems fail, and he quickly falls into a coma, and will die a few hours later. Hydrophobia is one of the characteristic symptoms of most manic rabies.

What are the symptoms of the four stages of rabies in children? Rabies is a very serious infectious disease, so we must do a good job in related prevention work. But what should you do if your child has rabies without paying attention? Don’t worry, let me tell you what are the symptoms of rabies in children.

　　 Symptoms of Pediatric Rabies

　　 incubation period

　　小儿狂犬病的incubation period长短不一，短至4天至7天，长至19年，但是绝大多数病患都是在1年以内。

　　影响incubation period的因素为年龄(儿童较短)、伤口部位(头面部发病早)、伤口性质(深咬伤较短)和入侵病毒的数量、毒力及宿主防御机制等。

　　 prodromal period

　　Most have low fever, headache, fatigue, general discomfort, loss of appetite, nausea, irritability, fear and restlessness, and then are sensitive to pain, sound, light, wind and other stimuli, and have a feeling of tightness in the throat. The early symptoms with more diagnostic significance are the healed wound, numbness, itching, pain and other abnormal sensations near the wound and its nerve pathways, and an ant crawling sensation in the extremities. This period lasts 2 to 4 days.

　　 exciting period

　　处在exciting period的狂犬病患儿会渐渐进入高度兴奋的.状态，他们的表现通常为恐水、怕风、怕光、极度恐怖以及呼吸困难等，甚至还会出现发作性咽肌痉挛的现象。

　　Most patients can cause severe spasm of throat muscles when they drink water, see water, hear the sound of running water or even hear the word water. Children are extremely thirsty, but dare not drink water, often resulting in hoarseness and dehydration. Stimuli such as wind, light, and touch can not only cause spasm of the pharyngeal muscles, but also can cause painful convulsions all over the body, dyspnea, hypoxia, and cyanosis caused by respiratory muscle spasm.

　　Due to enhanced sympathetic nerve function, profuse sweating, salivation, increased heart rate, and increased blood pressure may occur. Most of the children are conscious, but some children may have disorientation, hallucinations, delirium, and mental disorders. 1-3 days in this period.

　　 paralysis period

　　The spasms decreased or stopped, and the child gradually became quiet. The limbs are flaccid paralysis, and symptoms of eye muscle, facial muscle and masticatory paralysis may also occur. And then into a coma, can die quickly due to respiratory and circulatory failure. This period lasts 6 to 18 hours.

　　The whole course of rabies is about 3 to 5 days, and some will exceed 10 days, but the situation is very rare. It is rare to see cases of the paralytic type, because such patients mainly manifest high fever and progressive paralysis, and eventually die of exhaustion. The entire course of the disease is less than 10 days, only about 8 to 9 days.

　　For cases already in the attack stage, the diagnosis can be preliminarily established based on the patient’s past history of being bitten by rabies or suspected rabies or animals such as cats, wolves, and foxes. Diagnosis of the disease is more valuable. If it is not sure whether the biting dog or cat has rabies, the animal should be kept in a cage. If the animal does not get sick within 7 to 10 days, it can generally be ruled out that the animal has rabies.

　　The clinical diagnosis of rabies can be made when the patient has typical clinical symptoms such as excitement, mania, fear of water, fear of wind, spasm of throat muscles, profuse salivation, and paralysis. For those with no obvious symptoms, pay special attention to whether there are three fears (fear of water sound, light, and wind). If necessary, use fan, pour water, and turn on the light to test. Such as immunological antigen, antibody detection positive before death, postmortem animal inoculation of brain tissue and Nessler bodies found in the cytoplasm of neurons can be confirmed.

　　 Prevention of Pediatric Rabies

　　 1. Control and eliminate the source of infection

　　Strengthen the management of dogs, wild dogs should be killed as much as possible, domestic dogs should be registered and vaccinated. Rabid dogs should be killed immediately, burned or buried deeply, and the skin should not be peeled.

　　If it is not certain that they are rabies for a while, they should be isolated and observed for 10 days, and the brain tissue of the animals that were killed or died during the isolation period should be taken for pathogenic examination.

　　 2. Vaccination

　　It is one of the important measures to prevent and control rabies.

　　 (1) Rabies virus vaccine

　　Cell culture vaccines are currently used mainly, including:

　　 ① Human diploid cell rabies vaccine

　　It has strong immunogenicity, few adverse reactions, and fewer injections, but it is difficult to prepare and expensive.

　　 ②Primary Hamster Kidney Cell Rabies Vaccine

　　The potency is above 2.5U, safe to use.

　　 ③Refined Vero Rabies Vaccine

　　The immunogenicity and adverse reactions are similar to ①, but the price is lower. Others include refined chicken embryo rabies vaccine, refined duck embryo rabies vaccine and primary bovine kidney cell rabies vaccine.

　　 (2) Pre-exposure immunization

　　The objects are those with occupational risks, laboratory workers who have been exposed to rabies virus, and those who have close contact with rabies patients. 2 doses on days 0 and 28 and 3 doses on days 0, 7, 28 or 0, 28 and 56 are recommended, with each 1.0ml intramuscular injection or deep subcutaneous injection, or 0.1ml intradermal injection.

　　 (3) Post-exposure immunity

　　The standard immunization program (HDCV vaccine) recommended by WHO is intramuscular injection of 1ml on the 0th, 3rd, 7th, 14th and 28th day, and a booster once on the 90th day. The adjuvanted hamster kidney cell vaccine is recommended to use the 2-1-1 procedure, that is, intramuscularly inject 2 doses (2ml) on the same day, and intramuscularly inject 1ml each on the 7th day and the 21st day. Take the deltoid muscle at the injection site, and inject it into the anterolateral side of the leg in children. Should not be inoculated in the arm.

　　 3. Injection of immune serum

　　WHO recommends injecting human rabies immune globulin (HRIG) at the same time as vaccination, at a dose of 20 U/kg (the dose of equine rabies immune globulin is 40 U/kg), and doing a skin test first. If it is negative, inject it intramuscularly or half the dose in the wound Peripheral infiltration injection, and the other half volume intramuscular injection. If the skin test is positive, desensitization treatment is required (0.05ml diluted 20 times, 0.05ml diluted 10 times, 0.1ml, 0.2ml, 0.5ml, subcutaneously injected with undiluted antiserum, and observed for 15 minutes each time) before injection.

　　 Differentiation of rabies in children

　　Some cases are often misdiagnosed as neurosis in the early stage due to unclear bite history. Those with atypical symptoms after the onset are sometimes easily misdiagnosed as mental illness, tetanus, viral meningitis, and cerebral leptospirosis. Cases of quiet paralysis may be misdiagnosed as polio or Guillain-Barré syndrome.

　　破伤风患者incubation period较短，多为6～14天，常见症状为牙关紧闭，苦笑面容，全身性肌肉痉挛持续较久，常伴有角弓反张。而狂犬病肌肉痉挛呈间歇性发作，主要发生在咽肌。破伤风患者无高度兴奋及恐水现象，积极治疗多可治愈。

　　Severe mental changes (coma, etc.), meningeal irritation, cerebrospinal fluid changes, and clinical outcomes can help differentiate this disease from viral meningitis and other neurological diseases. Immunological antigen, antibody detection, and virus isolation can make a positive diagnosis.

　　Rabies should still be differentiated from rabies-like hysteria (pseudorabies). These patients have a history of being bitten by a dog and most of them are determined to be rabies or have a history of contact with sick animals. Symptoms similar to rabies will occur after several hours or days, such as tightness in the throat, ability to drink water, and mental excitement. , but no fever, no salivation, no fear of wind, or drinking water, may not cause throat muscle spasm. Such patients can quickly recover after hinting, persuasion, and symptomatic treatment.

　　此外，采用Semple疫苗接种后，可发生累及中枢神经系统的并发症，应与狂犬病相鉴别。仅并发脊髓炎者incubation period为注射开始后1～3周，从注射第1针算起，最短6天，最长者52天。

　　临床表现为接种过程中突然发热伴上升性麻痹或不全性横贯性脊髓病变，有截瘫与括约肌失禁。如并发弥漫性脑脊膜炎则发病较迟，incubation period5～8周。临床症状为头痛、发热、病毒染意识障碍与脊髓炎表现。

　　The above two complications are easily confused with paralytic rabies. The presence of neutralizing antibodies in cerebrospinal fluid is beneficial to the diagnosis of rabies, and the dynamic observation during the course of the disease and the judgment of the efficacy of adrenocortical hormone are helpful for clinical differentiation. Fatal cases must rely on animal vaccination to make a diagnosis based on the presence or absence of Nessler bodies and viral antigens.

　　 总结： 经过上述的文章对Symptoms of Pediatric Rabies，Prevention of Pediatric Rabies以及Differentiation of rabies in children等有关知识的具体介绍，各位朋友们现在应该都已经学会如何辨别小儿狂犬病了吧。因为狂犬病的incubation period又长又短，因此一定要重视哦。

what are the symptoms of rabies

Make it clear, are you asking about the disease in humans or animals?

Clinical stages and manifestations: The clinical manifestations of rabies can be divided into four stages.

1、incubation period：(平均约4-6周，最短和最长的范围可达10天-8个月)，根据个人体质不同incubation period的时间从几天到数年不等，在incubation period中感染者没有任何症状。

2、prodromal period：感染者开始出现全身不适、发烧、疲倦、不安、被咬部位疼痛、感觉异常等症状。

3、exciting period：人类：患者各种症状达到顶峰，出现精神紧张、全身痉挛、幻觉、谵妄、怕光怕声怕水怕风等症状因此狂犬病又被称为恐水症，患者常常因为咽喉部的痉挛而窒息身亡。

4、昏迷期：如果患者能够渡过exciting period而侥幸活下来，就会进入昏迷期，本期患者深度昏迷，但狂犬病的各种症状均不再明显，大多数进入此期的患者最终衰竭而死。

病理：狂犬病病毒进入人体后首先侵染肌细胞，在肌细胞中渡过incubation period,后通过肌细胞和神经细胞之间的乙酰胆碱受体进入神经细胞，然后沿着相同的通路进入脊髓，进而入脑，并不延血液扩散。病毒在脑内感染海马区、小脑、脑干乃至整个中枢神经系统，并在灰质大量复制，延神经下行到达唾液腺、角膜、鼻粘膜、肺、皮肤等部位。狂犬病病毒对宿主主要的损害来自内基小体，即为其废弃的蛋白质外壳在细胞内聚集形成的嗜酸性颗粒，内基小体广泛分布在患者的中枢神经细胞中，也是本疾病实验室诊断的一个指标。

Diagnosis: The diagnosis of rabies can be based on clinical symptoms or laboratory tests.

1. Clinical diagnosis: Diagnosis is mainly based on the above-mentioned clinical symptoms.

2. Laboratory diagnosis: examination of endogenous bodies in brain tissue; examination of antibodies by fluorescent immunoassay; animal inoculation experiment with secretions; serological antibody examination; reverse transcription PCR method to examine viral RNA.

Prevention and treatment:

1. Control the spread among wild animals;

2. Realized by feeding bait containing oral rabies vaccine;

3. Control the transmission among pets;

4. Mandatory rabies vaccination for pets;

5. Preventive immunization for susceptible groups;

6. Inoculate rabies vaccines for people who are prone to exposure to rabies virus.

Post-exposure preventive treatment: Wash thoroughly with 3%-5% soapy water or 0.1% bromogeramine or clean water. When washing deep wounds, use a syringe to penetrate into the deep part of the wound for perfusion cleaning, so as to be thorough. Then disinfect with 75% ethanol, followed by rubbing with concentrated iodine tincture. The earlier the local wound treatment is, the better. Even if it is delayed for 1-2 days or even 3-4 days, the local treatment should not be ignored. Infiltrate and inject rabies virus immune serum near the wound.

The serum treatment method began in 1899, and the effective treatment time is within 24 hours after being bitten.

The preparation method of rabies vaccine has utilization animal brain tissue culture, and human body diploid cell vaccine (HDCV), the vaccine of animal brain tissue production, human immune response is bigger, may cause encephalitis.

【Canine Symptoms】

Rabies, also known as mad dog disease, hydrophobia. It is a direct contact infectious disease of a human and all warm-blooded animals (human, dog, cat, etc.) caused by rabies virus. Once a person is bitten by a dog containing rabies virus, there is a 30-70% chance of infection, and once the disease occurs, the mortality rate is 100%. Therefore, dogs as pets must pay attention to rabies immunity. The clinical manifestations of a rabid dog are extreme excitement, mania, salivation and loss of consciousness, and eventually death due to general paralysis.

症状：本病的incubation period长短不一，一般为15天，长者可达数月或数年以上根据WHO验证，最长incubation period间为6年，incubation period的长短和感染的毒力、浓度、免疫力高低、部位等有关。

There are two types of clinical manifestations: one is violent type, and the other is paralytic type.

狂暴型：分三期，prodromal period、exciting period和paralysis period。

prodromal period表现精神沉郁、怕光喜暗，反应迟钝，不听主人呼唤，不愿接触人，食欲反常，喜咬吃异物，吞咽伸颈困难，唾液增多，后驱无力，瞳孔散大。此期时间一般1-2天。prodromal period后即进入exciting period，表现为狂暴不安，主动攻击人和其它动物，意识紊乱，喉肌麻痹。狂暴之后出现沉郁，表现疲劳不爱动，体力稍有恢复后，稍有外界刺激又可起立疯狂，眼睛斜视，自咬四肢及后躯。该犬一旦走出家门，不认家，四处游荡，叫声嘶哑，下颔麻痹，流涎。此种病犬对人及其它牲畜危害很大。一旦发现应立即通知有关部门处死。

paralysis period：以麻痹症状为主，出现全身肌肉麻痹，起立困难，卧地不起、抽搐，舌脱出，流涎，最后呼吸中枢麻痹或衰竭死亡。

Prevention: Rabies can be prevented by immunization with inactivated or modified live rabies vaccine. The immunization program is that dogs aged 3-4 months with live vaccines are immunized for the first time, and then immunized again when they are one year old, and then immunized every 2-3 years. After the inactivated vaccine is first immunized for dogs aged 3-4 months, the second immunization is carried out 3-4 weeks after the first immunization, and once every other year after the second immunization.

Rabies is very harmful to people. Once a person is bitten by a rabid dog, he should be injected with rabies vaccine as soon as possible. There is no disease, this is the process of antibody and virus race, once the disease occurs, the mortality rate is 100%. There is only one rescued case in the world, but it does not have the value of promotion. Therefore, animal owners must regularly inject rabies vaccines to other animals according to the immunization program to prevent being bitten by dogs. For large domestic dogs, they must be kept captive and tied to prevent them from being bitten by others. Once a person is bitten by an unknown dog, he or she should immediately go to the epidemic prevention department for emergency immunization. Control measures should be taken immediately when ownerless dogs and wild dogs are found.

Treatment: There is currently no medicine to treat this disease.

【Questions and Answers on Rabies】

1. What is rabies?

Rabies, also known as hydrophobia, is a zoonotic acute fatal infectious disease caused by rabies virus that mainly invades the central nervous system.

2. How is the resistance of rabies virus?

Generally speaking, the resistance of rabies virus is not strong and can be destroyed by sunlight, ultraviolet rays and ultrasonic waves. Strong alkali, strong acid, potassium permanganate and iodine can all kill it, and it will die soon in 1% or 70% alcohol. Gradually loses its infectious power after drying.

It is sensitive to the effect of temperature, and the virus can be completely killed when heated to 56°C for one hour, 10-15 minutes at 60°C, and 2 minutes at 100°C. But low temperature is a good living condition for viruses. The virus in the brain block can be preserved for several months at 4°C, and within several years at -70°C, and still maintains its infectious properties.

Everyone must distinguish the difference between in vitro survival and air survival, because rabies virus is an anaerobic bacteria, it loses its activity when exposed to air, and dies when the saliva dries up. The in vitro survival time refers to the condition that the environment is suitable and there is a culture medium to provide nutrients for the virus. Do not confuse it with air survival. In a natural environment, the rabies virus quickly loses its activity and dies. Not a live infection. (That is to say, scratching, scratching, animal activity directly contacting wounds or mucous membranes, as for inactive objects (food, utensils, etc.) that are contaminated with viruses and then transmitted to living people, there is no such medical record.

3. How many types of rabies virus are there?

There are two types of rabies virus:

1. The rabies virus isolated from patients and sick animals has the characteristics of being neurotropic and salivary gland-tropic, and can cause rabies in humans or animals. Its symptoms are dominated by madness, which is called manic rabies.

2. The rabies virus isolated from bats in Central and South America can cause rabies after infecting humans and animals. But the main symptom is paralysis. Called paralytic rabies. The characteristic of this virus is that it is both neurotropic and visceral, and its invasiveness is relatively weak. However, it can be transmitted by air, and the formation of Negi's bodies in the brain is not typical.

4. What are the sources of rabies infection?

There are two sources of rabies infection.

1. Rabid animals and people with rabies

All warm-blooded animals can be infected with rabies, but the sensitivity varies, and mammals are the most sensitive. In nature, rabies has been seen in domestic dogs, wild dogs, cats, wolves, foxes, jackals, badgers, pigs, cattle, sheep, horses, camels, bears, deer, elephants, hares, squirrels, weasels, bats and other animals. All cold-blooded animals such as fish, frogs, turtles, etc. can resist the infection of rabies virus.

In people suffering from rabies, the virus can be isolated in their saliva. In theory, although people can infect people, cases of human-to-human transmission are rare. There are only 6 human-to-human deaths caused by organ transplants in the world. In addition to human infection, there is no conclusive evidence of human-to-human infection. Therefore, people are not easy to be sensitive to each other,

2. "Healthy" dogs and animals with rabies

The World Health Organization and the Chinese Center for Disease Control and Prevention have admitted that healthy animals do not carry poison, and there is no possibility that the biting animal does not kill the human, and those have been proven to have no scientific basis. If the dog is not during or is about to become ill within 10 days, there is no virus in its saliva and it cannot infect you.

5. Why are dogs the main source of infection for rabies epidemics?

Because there is a habit of keeping dogs all over the world, among animals, dogs have the closest contact with people. In addition, dogs are highly mobile and have the characteristics of biting behavior, so dogs have become the main link in the rabies epidemic. According to statistics, the proportion of people suffering from rabies who are bitten by various animals is: 80.07% are bitten by dogs, 9.25% are bitten by cats, 0.64% are bitten by wolves, and 0.64% are bitten by foxes. The wounds accounted for 0.03%, and the bites by farm animals accounted for 0.64%. Among them, dogs account for the highest proportion and are also the most susceptible to rabies. Therefore, dogs are the main source of infection.

6. What are the modes of transmission of rabies?

Rabies is transmitted in three ways:

1. Infected by a dog or other animal bite or scratch on the skin or mucous membranes. Rabies virus invades nerves through wounds and mucous membranes to develop the disease. This is the main mode of infection.

2. Accidentally stabbed the hand during slaughter or skinning and infected the disease. According to statistics, among the 86 rabies patients, 78 were bitten, and 8 were infected by skinning and stabbing hands of slaughtered dogs.

3. Gastrointestinal infection. Animals that died of rabies were buried in the ground, frozen in winter, picked up by wild dogs or other animals, eaten the meat, and infected with rabies.

It is also a kind of infection that can only be caused in a special laboratory environment, that is, when the concentration of virus in the laboratory is particularly high, there may be aerosol and fly infection.

7. Meat from rabies-affected dogs, pigs and livestock, processed into mature meat. Can I get infected after eating it?

Humans cannot get rabies if the cooked meat of animals with rabies is cooked, because the rabies virus has died after being boiled at 100°C for 2 minutes and is not contagious. However, animals suffering from rabies are taboo to be slaughtered, skinned and eaten. To prevent skinning or cutting and stabbing hands or to infect chapped hands, it is dangerous to contact nerve fragments and saliva of affected animals.

8. Who are susceptible to rabies?

People are generally susceptible to rabies, but different groups of people have different chances of infection. There are more men than women, and more people under the age of 14, accounting for about 52% of the total. Among people under 14 years old, the ratio of male to female is 2.37:1. The reason why men are higher than women is that it is generally believed that men are more active, have more opportunities to go out, and have more chances of being bitten. Children aged 5-14, especially boys, are active, love to play with dogs, tease dogs, and love to provoke, so they are easy to be bitten. This age is also called "accident age", and they are prone to rabies.

9. After being bitten by mad dogs and animals, what factors are related to the incidence rate?

Morbidity after being bitten by a mad dog or other animal is related to six factors:

1. It is related to the bitten part. In the prevalence of bitten children aged 1-14, the incidence rate of the bite site is: the head accounts for 25.6%, the upper limbs account for 29.7%, the trunk accounts for 2.1%, and the lower limbs account for 27.8%. , Multiple bites accounted for 14.8%. The head and extremities have the highest incidence.

2. It is related to the sequence of being bitten. Those who are bitten first have more chances of developing the disease than those who are bitten later, which may be related to the amount of infected virus. For example, 12 people were bitten by a rabid dog in a certain place, among which 3 people who were bitten first died of the disease.

3. It is related to the depth of the wound and the number of wounds. Deep wounds, large wounds, and high numbers of wounds have a high incidence.

4. It is related to the presence or absence of clothing. The incidence of not wearing clothes is the highest; wearing single clothes in summer has a higher incidence than wearing cotton clothes in winter. This is because the teeth and saliva stained with viruses are less likely to enter the wound after being wiped by clothes.

5. It is related to whether the wound is treated in time. Those who treated the wound in time had a significantly lower incidence rate than those who did not.

6. related to vaccination. The rabies vaccine was injected in time on the day of being bitten, and the incidence rate was the lowest for those who were injected according to the whole process.

10. What factors are related to the prevalence of rabies?

The prevalence of rabies is mainly related to the following three factors.

1. The incidence of human rabies is mainly related to the surrounding dog environment. Because dogs are the main source of infection of rabies, such as free-range dogs, there are many dogs that are not vaccinated, so it is very easy to cause the epidemic of infectious diseases among dogs, which directly poses a great threat to people and increases the possibility of epidemics .

2. Depends on region and season. In southern regions with a warmer climate, rabies can occur throughout the year. In the cold northern regions, although rabies occurs all year round, the incidence rate is higher in warmer seasons due to less clothing. In the cold season, dogs are reluctant to go out, and people wear cotton-padded clothes, and the incidence rate drops. (It doesn't matter, it's just that the amount of virus infecting the wound caused by the isolation of clothes is different)

3. It is related to local attention and preventive measures. For example, local bait vaccines are given to wild creatures, stray dogs are prohibited, and domestic dogs are kept in captivity. As long as more than 75% of dogs are vaccinated, the infection route of rabies can be effectively cut off.

十一、what is rabies样的发病机理？

There may be a large amount of virus in the saliva of the sick animal. When the dog bites a person, the virus invades the wound and causes infection, reproduces in a small amount in the tissue, and then spreads along the peripheral nerves to the central nervous system and finally reaches the central nervous system of the brain. The virus infects the nerve at a rate of about 3 nanometers per hour. When the virus reaches the nerve roots on the dorsal side of the spinal cord, it begins to multiply. And invaded the joints of the spinal cord, and spread throughout the central nervous system within 24 hours. After entering the central nervous system (at this time, people became ill and developed encephalitis), and then the virus entered the salivary glands and returned to each nerve, and then centrifuged Sexual transmission, so many organs of patients in the later stage can be damaged to varying degrees.

12. What are the symptoms of rabies?

狂犬病的症状可分为：prodromal period。狂躁期。paralysis period三个阶段。

prodromal period：发病初，小儿常说头疼、不安，有恐惧感等神经性症状，也可出现恶心、呕吐等症状。体温高达37．5--38℃。患儿的性格或行为可发生改变，如清绪低落，抑郁和不安，有的易发怒。被咬伤的部位发红，伤口周围有刺痛或麻木，有肿胀，伴随有蚁走感和强烈瘙痒。伤口的变化是狂大病的重要鉴别，对早期诊断有很大帮助。进一步可出现喉部紧迫感，厌食，并有吞咽困难症状出现。此时一般为1--3天，有时可为7天。

狂躁期：又称为exciting period，可出现狂犬病年具有的独特症状，如恐水、阵发性的狂躁和流涎发作。病人想饮水时，便引起咽部的剧烈痉挛，呼吸也困难，十分痛苦。以后每当看到水或听到水声，甚至想到水，都可引起反射性发作，所以又称"恐水病"。咽部痉挛亦可扩散到呼吸肌，呼吸困难，病人可出现发绀现象，亦可见瞳孔散大。发作间歇期间病人意识清楚，随着阵发性痉挛加剧，病人时时出现狂躁行为。由于交感神经兴奋，病人出现大汗及流涎，加上呕吐及进食进水的障碍，很快即出现脱水。体温高达39--40℃。此期经过1--3天。

paralysis period：病人渡过狂躁期转狂躁为安静，痉挛逐渐停止，反应迟钝，还可少量进食，一般家人常以为病情好转。实际很快出现脑神经与四肢神经麻痹，终因呼吸循环衰竭而死亡。此期较短，一般为15--20小时。

Thirteen, how to diagnose and differential diagnosis of rabies?

prodromal period症状不太明显时，一般不易诊断。询问有无咬伤史，或伤口处有无异常感觉可帮助诊断。若有典型的怕水或咽部痉挛，则是不难诊断的。

Differentiation from other diseases in the diagnosis are:

(1) Rabies phobia: These patients are often people who have knowledge of rabies or have seen rabies patients attack. This kind of person is very afraid of rabies, and there are symptoms of mental terror in the pain of the bite site. But this kind of patient has no low-grade fever, no real spasm of throat muscles when exposed to water, and no fear of water.

（2）破伤风：两者的症状有相似处，但破伤风incubation period短，为6-14天，有外伤史。出现牙关紧闭，角弓反张及长时间的强直性全身痉挛等典型症状，而狂犬病以局部痉挛为主，持续时间也短。

(3) Meningitis and encephalitis are often confused with the prodromal symptoms of rabies. But there is no history of biting, and the mental state is dull, lethargic, coma and convulsions, which are different from the symptoms of rabies such as clear consciousness and panic. In addition, rabies should also be distinguished from polio, central nervous system drug poisoning, and uremia.

14. How to prevent rabies?

To avoid rabies, do the following:

(1) It is necessary to strengthen publicity and make every parent, especially children, tell the dangers of rabies. To increase the knowledge of rabies prevention. It is especially necessary to educate children, especially young children, to take good care of them, not to play with or tease dogs, and not to come into contact with dogs. Dogs and small animals that are not crazy and appear to be healthy may carry the rabies virus. Children's resistance is weak, and they are easily thrown down by dogs, biting their heads and upper limbs. The incidence rate is the highest and the most dangerous.

(2) Dogs are the main source of infection of rabies. If a mad dog is found, it must be resolutely captured and quarantined or killed and buried. People who raise dogs must lock up and take care of the dogs according to regulations to prevent infection and injury. And regular veterinary vaccinations should be given to dogs.

（3）被咬伤后，要立即清水或肥皂水清洁伤口，严重的要及时到医院处理。因为伤口是病毒侵入的门户。处理好后可直接防止感染，或可延长incubation period。

(4) Rabies vaccine should be injected in time after being bitten or after treatment. Because once the disease occurs, there is no way to treat it, and the vaccine must be injected according to the regulations throughout the whole process. This is the most effective way to prevent the occurrence of rabies.

15. How many preventive measures are there for being bitten by a mad animal?

There are three preventive methods, timely and thorough cleaning of wounds, use of immune serum, and vaccination are listed as "three major steps". Each accounts for one-third of its importance and is indispensable. In actual work, what is often overlooked is wound treatment, followed by immune serum.

16. How to deal with the wounds bitten by mad animals?

In order to prevent the rabies virus in the saliva of crazy animals from contaminating the wound and entering the body to cause infection, it is recommended to wash the wound repeatedly with soapy water and squeeze out the blood; other disinfectants, such as 40%-70% alcohol or vinegar or white wine, can also be used for washing. Or directly wash the wound with a large amount of water. Because rabies virus is not resistant to strong acid, strong alkali and high temperature, it will be killed at 56°C for 15 minutes, 60°C for 5 minutes, and 100°C for 2 minutes. Clothes torn by rabid animals should be replaced in time and boiled , to prevent "non-bite contact infection" from re-contacting skin or mucous membranes. It is strictly forbidden to peel and eat the mad animals that are killed, and they should be burned in time to prevent wild animals from digging up the soil and chewing on the corpses, which will pollute the environment.

17. How to use the immune serum?

First, infiltrate injection at the injured site, not less than 5mL, 0.5mL per kilogram of body weight (increase to 1.0-1.5mL as appropriate for severe bites), intramuscular injection in several times, on the day after the injection Or start the vaccine the next day. But care must be taken to avoid injecting serum and vaccine at the same site.

18. How to do allergy test before injection of immune serum?

Dilute the immune serum 10 times with normal saline (0.1 mL serum plus 0.9 mL saline), inject 0.05 mL intradermally on the volar side of the forearm, and observe for 30 minutes. If there is no obvious reaction at the injection site, it is negative. Immune sera can be used directly under observation. If there are enlarged, red, swollen and infiltrated skin mounds at the injection site, especially those that look like pseudopods or feel itchy, it is a positive reaction and must be desensitized. The local reaction of the injection is particularly severe or accompanied by systemic symptoms in addition to the local reaction; hives, nasopharyngeal itching, sneezing, etc., are positive reactions, and desensitization injections should be used; if anaphylactic shock occurs, immediately inject 1/1000 epinephrine 0.5 - 1.0mL, or other corresponding measures.

19. How to do a desensitization test?

Dilute the serum 10 times with normal saline, subcutaneously inject several times in small amounts, and observe for 15--30 minutes after each injection. Inject 1.0 mL for the first time. If there is no cyanosis, wheezing or significant shortness of breath, and the pulse speeds up, you can inject 2.0 mL for the second time. If there is still no response after the injection volume reaches 4.0 mL, inject the full amount slowly. , Outpatients must be observed for at least 30 minutes after injection of immune serum before leaving.

20. How to use concentrated rabies vaccine?

Bite victims were injected with 1 ampoule of concentrated rabies vaccine (1 mL or 2 mL of liquid 2 mL freeze-dried vaccine) on days 0 (1st day), 3, 7, 14, and 28 days, and the dosage for children was the same. Severe bites (head, face, neck, fingers, more than 3 bites on multiple parts. Those who bite through the skin or touch the mucous membrane) should be injected with a double dose of vaccine on the 0th and 3rd day, and the vaccine should be administered at the same time as the 0th day. Anti-rabies serum. Those who use anti-rabies serum in combination must inject booster injections 2 to 3 times after the full vaccination, that is, inject booster injections 15 days, 75 days, or 10, 20, and 90 days after the full injection. The vaccine is injected intramuscularly into the deltoid muscle of the upper arm or the inner thigh. Children should be injected intramuscularly in the anteromedial area of ​​the thigh.

【关于狂犬病incubation period】

任何传染病被细菌或病毒感染后，都要经过一段时间才发病，incubation period间人没有任何症状，这段时间就叫incubation period。

狂犬病的incubation period波动最大，可从6天、12天到1年或5年以上，一般是2周到3个月内发病，99%在1年内发病，1%在1年以上发病，但实际上超过1年半都已经是十分罕见的，经考证最长的incubation period为6年，WHO有实际验证证明的是两个6年的病历，中国所谓极特殊的长达30年至40年的没有任何确凿的证据。

是否处于incubation period？一般动物发狂犬病死亡的前一二周内（一般是五六天），它们的口腔分泌液（如口水）中才会带病毒。所以，如果你被咬了，而狗在此后的二周内仍然正常，即没有发生狂犬病而死亡，则你不会被感染。

如果可能处于incubation period（如数月，数年），只要没有发病，接种都有效，此时应使用变五针法进行接种，即当天、第三天分别在双臂三角肌各注射一针疫苗，第七天注射一针疫苗（共五针）。只要人体能在病毒侵入到神经中枢之前产生足够的抗体控制病毒的扩散，人就不会再发病了。所谓疫苗不是100%有效，是由于病毒在人体没有产生足够抗体之前就已经扩散到神经中枢，进而入脑，这个过程中人就会有发病的症状了。一般狂犬咬伤后，人体受感染，入侵人体的病毒会度过一个incubation period，一般为二周到三个月不等，才最终扩散到脑，从而使人发病，所以，只要在incubation period内接种后，人体在病毒还没扩散到脑之前产生了足够多的抗体控制病毒，则人就不发病了。一般咬后及时接种，一周左右内人体就会产生大量抗体，第四针与第五针一般是加强作用，而病毒扩散一般需要二周到三个月不等（长短与咬伤部位，咬伤程度，病毒量与毒性强弱有直接关系，极少数人incubation period可达二年以上），所以一般及时接种后，人就不会发病。

Of course, if there is no disease within several years (such as more than two years) after exposure, it is generally not necessary to vaccinate again, because the possibility of disease is too small.

【Precautions】

1. Vaccination reactions and contraindications.

Vaccination reaction

(1) Local reaction

A few patients had pain, redness, induration, itching at the injection site, and even edema and enlarged lymph nodes. Systemic reaction: refined VERO cell rabies vaccine and refined hamster kidney cell vaccine, because the vaccine is purified and has very few impurities, side effects of vaccination are rare or mild.

(2) Taboo

1. Therapeutic vaccination: Since rabies is a fatal disease, any contraindications are secondary to saving lives, so there are no contraindications for prophylaxis after being bitten by a rabid animal.

2. Preventive vaccination: Under the premise of ensuring that there will be no chance of contact with the source of infection and rabies virus in the near future, the vaccination can be postponed for those who are pregnant, have acute diseases, allergies, use steroids and immunosuppressants.

3. People who are allergic to streptomycin and neomycin should use it with caution.

2. Common types of rabies vaccines.

1. Attenuated rabies vaccine (Pasteur) prepared from rabbit brain marrow.

2. Rabies sheep brain vaccine (attenuated).

3. Hamster kidney cell rabies vaccine.

4. Human diploid cell rabies vaccine.

5. Vero cell rabies vaccine.

6. Human oral rabies vaccine (under research)

Most of the currently used rabies vaccines are purified from Vero cells. There is also a rabies vaccine purified from hamster kidney cells. Vero cells are currently the rabies vaccine with the best effect and the least side effects.

Purified vaccine is to remove the impurities in the vaccine. to reduce adverse reactions.

What are the symptoms of rabies?

Rabies is a natural foci or zoonotic acute infectious disease caused by rabies virus. It is widespread and has a high fatality rate, posing a serious threat to people's lives and health. The typical clinical manifestation of rabies is hydrophobia, so rabies is also called hydrophobia.

初期对声、光、风等刺激敏感而喉部有发紧感，进入exciting period可表现为极度恐怖、恐水、怕风、发作性咽肌痉挛、呼吸困难等，最后痉挛发作停止而出现各种瘫痪，可迅速因呼吸和循环衰竭而死亡。

Human rabies is mainly caused by biting, scratching or mucous membrane infection of sick animals, and it can also be transmitted through respiratory aerosol under certain conditions. The saliva of infected animals contains rabies virus. Infected animals are mainly dogs (more than 90%), followed by cats.

Extended information:

Be vaccinated against rabies

The doctor said that humans are also omnivores, and the mouth is not as clean as imagined, and may contain hundreds of bacteria. After being bitten by a person, you should first wash it with plenty of soapy water, go to the nearest hospital to treat the wound, get a tetanus shot within 24 hours, and go to the local Center for Disease Control and Prevention to get a rabies vaccine. No special treatment is required for those with no broken skin.

The second is to learn as much as possible about whether the other party has other infectious diseases, and if necessary, do corresponding inspections to prevent problems before they happen. The doctor also reminded that for biters, there are actually risks as well, because the bitten person may carry certain pathogenic bacteria or viruses, or the bitten person is a patient of some kind of infectious disease, and the biter may pass through the digestive tract or damage the body. The oral mucosa is infected.

Reference source: People's Daily Online - A man was bitten by a doctor. The doctor persuaded him to get a rabies vaccine. What are the symptoms of rabies?

What are the symptoms of rabies

The typical three fears (phobia of wind, fear of water, and fear of light) of rabies patients accounted for 60%, and the other 40% had atypical symptoms.

incubation period因为个体差异导致时间差异大。大多数在3个月以内发病，超过半年者占4%～10%，超过1年以上者约1%，文献记载最长1例达19年。平均20-90天。

影响incubation period长短的因素为年龄(儿童较短)、伤口部位(头、面部发病较早)、伤口深浅(深者发病早)、病毒入侵数量及毒株的毒力、受伤后是否进行了正规的扩创处理和接种狂犬病疫苗预防等。其他如外伤、受寒、过度劳累等均可能促使提前发病。由吸血蝙蝠啮咬而引起的狂犬病，绝大多数病例不出现exciting period，也无咽肌痉挛和恐水现象，而以上行性瘫痪为主要临床表现。

The clinical manifestations can be divided into manic type (encephalitic type) and paralytic type (static type). The lesions of manic rabies are mainly in the brainstem, cervical nerves or higher parts of the central nervous system, while the lesions of paralytic rabies are limited to the spinal cord and oblongata, resulting in differences in clinical symptoms. Both can be divided into the following three periods:

1.prodromal period

两型的prodromal period相似。在兴奋状态出现前大多数患者有低热、嗜睡、食欲缺乏，少数有恶心、呕吐、头痛(多在枕部)、背腰痛、周身不适等;对痛、声、光、风等刺激开始敏感，并有咽喉紧缩感。具有重大诊断意义的早期症候，是已愈合的伤口部位及神经通路上，有麻木、发痒、刺痛或虫爬、蚁走等感觉异常，约发生于80%的病例。这是由于病毒繁殖刺激神经元，特别是感觉神经元而引起，此症状可维持数小时至数天。本期持续1～2天，很少超过4天以上。

How much do you know about rabies?

Rabies is not uncommon in our daily life, usually in dogs or cats. Rabies is an acute infectious disease caused by rabies virus. Most people who suffer from rabies are infected because they are bitten by animals carrying rabies virus.

The manifestations of people suffering from rabies are: fear of water, fear of wind, spasm of pharyngeal muscles, progressive paralysis, etc. Rabies in my country is mainly transmitted by dogs, and domestic dogs can become asymptomatic carriers, so apparently healthy and asymptomatic dogs pose a great health hazard to people. At present, there is still no particularly effective treatment for rabies in my country. The fatality rate of human rabies is close to 100%. Patients generally die of respiratory or circulatory failure within 3 to 6 days, so preventive measures should be strengthened.

Rabies virus attacks the central nervous system of the body. Maybe your dog loves you very much, but he may still bite you when he has a rabies attack, and his behavior is out of control at this time. It's not that it wants to bite you, it's that rabies is biting you. Of course, an infected animal may also stand still and then suddenly bite. So keep your distance where you need to be. If you are unfortunately bitten, you can simply treat the wound before going to the hospital. Rinse the wound with tap water, followed by a mild alkaline solution, such as soapy water. Your dog may have been vaccinated, but that doesn't guarantee that he doesn't have the virus. Dogs do not necessarily produce immune antibodies after vaccination or the vaccination may be ineffective.

Therefore, rabies is a disease that cannot be ignored. If you have dogs or cats at home, take them to get vaccinated in time. And after being bitten, clean up the wound as soon as possible, and rush to the hospital in time for rabies vaccination. Only in this way can it effectively resist the damage of rabies virus to body functions. Life is precious, do it and cherish it.

What are the clinical manifestations of rabies?

The typical clinical course of rabies can be divided into the following 3 phases:

1.prodromal period或侵袭期

Before the excited state appeared, most patients had low-grade fever, loss of appetite, nausea, headache, fatigue, general discomfort, etc., which resembled a "cold"; crunch. The early symptoms with more diagnostic significance are paresthesia in the wound and its vicinity, such as numbness, itching, pain, and ants, which are caused by stimulating neurons when the virus reproduces, and last for 2 to 4 days.

2.exciting period

The patient gradually entered a state of high excitement, with prominent manifestations such as extreme terror, fear of water, fear of wind, paroxysmal pharyngeal muscle spasm, dyspnea, difficulty urinating and defecating, and excessive sweating and salivation. This period lasts for 1 to 3 days.

Fear of water is a special symptom of rabies. When a typical person sees water, drinks water, listens to the sound of running water, or even just mentions drinking water, it can cause severe throat muscle spasm. Fear of wind is also one of the common symptoms. Breeze or other stimuli such as light, sound, touch, etc., can cause spasm of the pharyngeal muscles, and severe fashion can cause painful convulsions all over the body.

3.paralysis period

The spasm stopped, and the patient gradually became quiet, but flaccid paralysis occurred, especially limb flaccidity. Eye muscles, facial muscles, and masticatory muscles can also be affected, manifested as strabismus, ocular movement disorders, jaw drop, inability to close the mouth, lack of facial expression, etc. This period lasts for 6 to 18 hours.