Description Rabies is a disease of mammals caused by a member of the Lyssavirus genus of the Rhabdovirus family. Rabid animals can show wide range of clinical signs. The index of suspicion for rabies should be high in an endemic area as this is one of the world’s most important zoonotic diseases. Diagnosis is confirmed by identification of the virus by public health officials.

Rabies is an acute viral encephalomyelitis that principally affects carnivores and bats, although it can affect any mammal. It is invariably fatal once clinical signs appear. Rabies is found throughout the world, but a few countries claim to be free of the disease due either to successful elimination programs and/or to their island status and enforcement of rigorous quarantine regulations.

Clinical signs of rabies are rarely definitive. Rabid animals of all species usually exhibit typical signs of CNS disturbance, with minor variations among species. The most reliable signs, regardless of species, are acute behavioral changes and unexplained progressive paralysis. Behavioral changes may include sudden anorexia, signs of apprehension or nervousness, irritability, and hyperexcitability (including priapism). The animal may seek solitude. Ataxia, altered phonation, and changes in temperament are apparent. Uncharacteristic aggressiveness may develop—a normally docile animal may suddenly become vicious. Commonly, rabid wild animals may lose their fear of humans, and species that are normally nocturnal may be seen wandering about during the daytime.

The clinical course may be divided into 3 phases—prodromal, excitative, and paralytic/endstage. However, this division is of limited practical value because of the variability of signs and the irregular lengths of the phases. During the prodromal period, which lasts ~1-3 days, animals show only vague CNS signs, which intensify rapidly. The disease progresses rapidly after the onset of paralysis, and death is virtually certain. Some animals die rapidly without marked clinical signs.

The term “furious rabies” refers to animals in which aggression (the excitative phase) is pronounced. “Dumb or paralytic rabies” refers to animals in which the behavioral changes are minimal, and the disease is manifest principally by paralysis.

Furious Form:

This is the classic “mad-dog syndrome,” although it may be seen in all species. There is rarely evidence of paralysis during this stage. The animal becomes irritable and, with the slightest provocation, may viciously and aggressively use its teeth, claws, horns, or hooves. The posture and expression is one of alertness and anxiety, with pupils dilated. Noise invites attack. Such animals lose caution and fear of other animals. Carnivores with this form of rabies frequently roam extensively, attacking other animals, including people, and any moving object. They commonly swallow foreign objects, eg, feces, straw, sticks, and stones. Rabid dogs may chew the wire and frame of their cages, breaking their teeth, and will follow a hand moved in front of the cage, attempting to bite. Young pups can seek human companionship and are overly playful, but bite even when petted, usually becoming vicious in a few hours. Rabid skunks may seek out and attack litters of puppies or kittens. Rabid domestic cats and bobcats can attack suddenly, biting and scratching viciously. As the disease progresses, muscular incoordination and seizures are common. Death results from progressive paralysis.

Paralytic Form:

This is first manifest by paralysis of the throat and masseter muscles, often with profuse salivation and inability to swallow. Dropping of the lower jaw is common in dogs. Owners frequently examine the mouth of dogs and livestock searching for a foreign body or administer medication with their bare hands, thereby exposing themselves to rabies. These animals may not be vicious and rarely attempt to bite. The paralysis progresses rapidly to all parts of the body, and coma and death follow in a few hours.

Species Variations:

Cattle with furious rabies can be dangerous, attacking and pursuing humans and other animals. Lactation ceases abruptly in dairy cattle. The usual placid expression is replaced by one of alertness. The eyes and ears follow sounds and movement. A common clinical sign is a characteristic abnormal bellowing, which may continue intermittently until shortly before death.

Horses and mules frequently show evidence of distress and extreme agitation. These signs, especially when accompanied by rolling, may be interpreted as evidence of colic. As in other species, horses may bite or strike viciously and, because of their size and strength, become unmanageable in a few hours. People have been killed outright by such animals. These animals frequently suffer self-inflicted wounds.

Rabid foxes and coyotes often invade yards or even houses, attacking dogs and people. The abnormal behavior that can occur is demonstrated by the fox that attacks a porcupine; finding a fox with porcupine quills can, in most cases, support a diagnosis of rabies.

Rabid raccoons and skunks typically show no fear of humans and are ataxic, frequently aggressive, and active during the day, despite their often crepuscular nature. In urban areas, they may attack domestic pets.

In general, rabies should be suspected in terrestrial wildlife acting abnormally. The same is true of bats that can be seen flying in the daytime, resting on the ground, attacking people or other animals, or fighting.

Rodents and lagomorphs rarely constitute a risk for rabies exposure. However, each incident must be evaluated individually. Reports of laboratory-confirmed rabies in woodchucks are not uncommon in association with the raccoon rabies epizootic in the eastern USA.