The length that symptoms have been present can be used to rule out rabies. Rabies infection is very unlikely in a patient who has an extended duration of illness.

Most patients with rabies infections will lapse into coma and life support is required within a short period of time. If a patient has been placed on life support and then recovered enough for it to be removed, rabies can be ruled out. Likewise, it can be ruled out on a patient on life support whose condition has not progressively worsened.

With many conditions, improvements and relapses are fairly common. This is not so with rabies, as the course of the disease is relentlessly downhill. Once symptoms begin, the patient will steadily deteriorate until death. Rabies can be ruled out in patients whose conditions improve.

If the facility has not yet instituted these precautions, why does the physician feel that rabies should be high on the list of differential diagnoses? Additionally, if the physician does feel that rabies is a valid possibility, these precautions need to be taken immediately.

Many times physicians have not considered drug abuse, alcoholism, or possible pesticide (or other chemical) exposure as a possible etiology.

If antemortem specimens are going to be submitted, call the Texas Department of State Health Services (DSHS), Zoonosis Control Group (ZCG), at 512-776-7255 to obtain the latest copy of CDC's protocol and patient information form. This form must be used if specimens are going to be submitted to CDC.

Postmortem testing is also available through CDC.  If specimens for either antemortem or postmortem rabies testing are going to be submitted to CDC, call the Texas Department of State Health Services (DSHS), Zoonosis Control Branch (ZCB), at 512-776-7255 to obtain the latest copy of CDC's protocol and patient information form.  This form must be used if specimens are going to be submitted to CDC.