What are the key signs and symptoms of rabies that I should be aware of when evaluating a patient with a history of animal exposure?

When evaluating a patient with a history of animal exposure, the key signs and symptoms of rabies to be aware of initially include nonspecific prodromal symptoms such as fever, headache, malaise, and general weakness. These early symptoms typically appear within 1 to 3 months after exposure but can vary depending on the site and severity of the bite NICE CKS Kauffman & Goldmann 1986. As the disease progresses, more specific neurological symptoms develop, including anxiety, agitation, confusion, and hyperactivity. Classic signs include hydrophobia (fear and difficulty swallowing water) and aerophobia (fear of drafts or fresh air), which are hallmark features of rabies encephalitis NICE CKS Hemachudha 1997. Other neurological manifestations may include paralysis, seizures, excessive salivation, and hallucinations. The clinical course rapidly deteriorates to coma and death if untreated NICE CKS Kumar et al. 2023. It is critical to consider these symptoms in the context of a history of animal bites or scratches, especially from high-risk species such as dogs, bats, or other wild mammals NICE CKS Kumar et al. 2023. Early recognition of these signs is essential for prompt post-exposure prophylaxis and management NICE CKS.