Both rabies and Guillain-Barre Syndrome may present with an ascending paralysis following a viral-like infection. The underlying cause may be identified based on a review of clinical findings.
Patient selection: ascending flaccid paralysis
Parameters:
(1) fever
(2) sensory involvement
(3) signs of encephalitis
(4) diagnostic tests for rabies (PCR, antigen, antibody)
Clinical Finding
Rabies (Paralytic or "Dumb" Form)
Guillain-Barre Syndrome
fever
present, often high
often afebrile
sensory involvement
absent
present
encephalitis
present
absent in oxygenated patients
tests for rabies
positive
negative
where:
• Some tests for rabies may give false negative results early in the course of disease. Therefore, a high index of suspicion, different types of tests and repeat testing is needed for maximum diagnostic yield.
• A history of animal bite or exposure may suggest rabies, but rabies may develop months or even years after the exposure and so its absence may not be helpful.
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