Symptoms include a prodrome of 1 to 4 days followed by fever, headache and malaise. Subsequently, agitation, hyperesthesia, hydrophobia, dyshpagia, paralysis, and death ensue. The most concerning bites are by skunks, bats, foxes, coyotes, bobcats, and racoons. Animals that only rarely transmit rabies include squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, rabbits, hares, and other rodents. Other animals should be considered on an individual basis depending on the circumstances of the bite.
Postexposure treatment is with rabies immune globulin and human diploid cell rabies vaccine.
Prophylactic treatment with HDRV can be given for those at high risk such as veterinarians, spelunkers, and virologists. Most are trivial, but complications include cellulitis, osteomyelitis, septic arthritis and sepsis. Wound infection is increased in likelihood with victims older than 50, immunosuppressed patients, puncture wounds, bites to dependent areas, and wounds not promptly irrigated. Common pathogens include Pasteurella multocida, S. aureus, and Streptococcus. Rabies and tetanus prophylaxis should be considered.