Rabies physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Common physical examination findings of rabies include hyperpyrexia alternating with hypothermia, tachycardia, respiratory collapse, hypersalivation, lacrimation, sweating, dilatation of the pupils and bradycardia. Skin findings may include percussion myoedema, bite marks and bruises.

• Hyperpyrexia alternating with hypothermia
• Tachycardia 
• Respiratory and vascular collapse
• Bradycardia

• Percussion myoedema (mounding of the muscle at the percussion site)^[1]
• Bite marks
• Bruises

• Hypersalivation
• Lacrimation
• Sweating
• Dilatation of the pupils

• No abnormal findings

• Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally, if aspirated.
• Wheezing may be present due to aspiration or chest infection
• Normal/reduced tactile fremitus

• S1 normal, soft
• S2 normal

• Guarding may be present

• No abnormal findings

• Opisthotonos
• Altered mental status
• Increased tendon reflexes with extensor plantar responses
• Flaccid paralysis with generalized areflexia when patient develops coma
• Nuchal rigidity
• Increased muscle tone
• Fasciculations

• Bite marks
• Muscle atrophy
• Fasciculations in the upper/lower extremity

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