Rabies Infection Specialist Doctor in Mumbai Rabies has the highest case fatality rate of any human infectious disease. Most of the rabies related deaths occur in developing countries because of inadequate control of rabies in domesticated animals. Most rabies is acquired through exposure to saliva from an animal bite. In rare cases, rabies result from a non – bite exposure ( e g, saliva contact with open skin or mucous membranes ) or transplantation of tissue or organs from a donor with unrecognized rabies. No transmission of rabies has been documented from infected patients to health care personnel or household contacts or by fomites or environmental surfaces. In developing countries, rabid dogs account for 90 percent or more of reported cases of rabies transmitted to humans. The average incubation period of rabies is one to three months, but can range from several days to many years after an exposure. Rabies usually starts with non - specific symptoms, such as low grade fever, chills, malaise, myalgias, weakness, fatigue, anorexia, sore throat, nausea, vomiting, headache. Infection may evolve into two major forms , including encephalitic rabies or paralytic rabies. In humans, encephalitic rabies is more common. The classic presentation of encephalitic rabies include fever, hydrophobia, hyperactivity subsiding to paralysis, coma and death. Hydrophobia is the most characteristic clinical feature. The patient develops overwhelming terror of water based on involuntary pharyngeal muscle spasms during attempts to drink. Aerophobia occurs less often than hydrophobia. Pharyngeal spasms are triggered upon feeling a draft of air. The facial muscles may contract leading to a grimace, and the neck and back can become hyperextended with muscle spasticity. Patients may become aggressive and maniacal followed by periods of calm. Most patients with rabies die, within two weeks after onset of coma. There is no known effective treatment for rabies, although the disease can be very effectively prevented after recognized exposure using post – exposure rabies prophylaxis and proper wound care. The decision to initiate rabies post - exposure prophylaxis should be made following a thorough risk assessment by a specialist. The post - exposure prophylaxis should begin as soon as possible. The WHO recommendations for post exposure prophylaxis is desirable. All the five doses of immunization should be completed and guidance from a specialist should be sought at the earliest.