Editorial: Diagnosis and management of human rabies.

Diagnosis and Management of Human RabiesRecently two patients died of rabies in London hospitals.Though both patients were infected abroad, this tragic coincidence has concentrated public attention on a problem which seems to threaten Britain now more than at any other time since the last important outbreak in 1918-22.The adequacy of quarantine regulations has been questioned.'An epizootic of fox rabies is spreading across France, animals are being smuggled into Britain, and our membership of the Common Market is likely to increase cross-Channel traffic of all kinds.So medical practitioners in this country may be increasingly concerned in the management of people bitten by potentially rabid animals while abroad and even in the early diagnosis of rabies encephalitis.In a timely article in this issue of the B.M.J. (p.740) Dr. L.Klenerman and colleagues rightly emphasize the risks of bites by imported laboratory animals and the need for a well- defined plan of action for dealing with such accidents.Proper treatment started soon after the bite can reduce the risk of developing rabies,2 3 but once the virus has reached the central nervous system and produced symptoms of the disease the outlook is virtually hopeless.The incubation period varies from 10 days to many years, but is usually one or two months.The illness starts gradually with a few days of non-specific prodromal symptoms including fever, headache, myalgia, chills, sore throat, respiratory and gastrointestinal upsets, insomnia, and anxiety and other psychological disturbances.