Clinical presentation and stages
The disease develops in stages, passing through several characteristic periods:
- Prodromal period — the initial stage characterized by general malaise, sleep disturbances (insomnia), as well as a feeling of causeless fear and anxiety.
- Excitation stage — a sharp increase in reflex excitability, the appearance of laryngeal and pharyngeal spasms, noisy breathing, and seizure syndrome. Specific phobias arise that trigger convulsions:
- Hydrophobia (reaction to the sight of running water);
- Aerophobia (fear of a draft of air);
- Photophobia (sensitivity to bright light);
- Akustophobia (reaction to noise).
Hallucinations are also possible.
- Paralytic stage — the final stage, occurring on days 3–7 of the disease. It is accompanied by paralysis of the limb muscles and depression of the respiratory center.
Special forms and clinical variants
Rare and atypical forms of the clinical course are distinguished in medical practice:
- "Quiet rabies" — a rare variant occurring without pronounced excitation and hydrophobia. The clinical picture is limited to the development of paralysis and profuse salivation.
- Local and generalized forms — differ in the degree of symptom spread and the severity of the patient's condition.
- Rose's tetanus is a local facial paralytic variant presenting with pronounced trismus, dysphagia, facial asymmetry (facial nerve palsy on one side and tonic muscle tension on the other), as well as nuchal rigidity.
Diagnostic tasks and management tactics
Analysis of clinical cases requires a clear action algorithm:
- In wound and postoperative tetanus, emergency hospitalization and specific therapy are of key importance: administration of antitetanus serum (ATS), tetanus toxoid, as well as the use of neuroleptic agents and muscle relaxants.
- An important aspect is the differential diagnosis of trismus between the initial manifestations of tetanus and odontogenic pathology (e.g., inflammatory contracture of the masticatory muscles due to periostitis).
- It is necessary to take into account the risk of allergic complications (serum sickness) in response to the administration of heterologous sera.
Class and exam questions
What specific phobias are characteristic of the excitation period?
Specific phobias include hydrophobia (reaction to running water), aerophobia (fear of a draft of air), photophobia (fear of light), and acoustophobia (fear of noise).
What are the features of the rare form of "quiet rabies"?
This form occurs without excitation stages and hydrophobia, manifesting exclusively with paralysis and hypersalivation.
What are the main directions of medical tactics in generalized forms?
Treatment includes emergency hospitalization, administration of antitetanus serum, use of muscle relaxants, neuroleptic mixtures, and maintenance of vital functions.
What else to study on this topic
- Factors of the incubation period duration and the influence of bite localization
- Age-related features of children's airways and broncho-obstructive syndrome
- Epidemiological history and differential diagnosis of febrile conditions
- Laboratory blood and CSF parameters in infectious lesions
- Complications of serotherapy and the development of serum sickness
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