Browse categories and answer follow-up questions to refine your symptom profile.
History
Exposure details
Bite exposure profile
Species
Dog
Cat
Bat
Raccoon
Skunk
Fox
Rodent
Livestock
Other wildlife
Exposure type
Bite
Scratch
Saliva contact with mucosa
Saliva contact with non intact skin
Aerosol exposure
Provoked vs unprovoked
Defensive bite during handling
Unprovoked attack
Location and setting
Home pet
Stray
Farm
Wilderness
Travel exposure
Time since exposure
Less than 8 hours
8 to 24 hours
More than 24 hours
Single vs multiple wounds
Single wound
Multiple wounds
Wound characteristics
Wound profile
Site
Face
Scalp
Neck
Hand
Wrist
Forearm
Leg
Foot
Genital
Wound type
Puncture
Laceration
Crush injury
Avulsion
Depth indicators
Visible tendon
Visible bone
Joint penetration concern
Contamination
Foreign material
Soil
Water exposure
Rabies specific history
Rabies risk history
Animal available for observation or testing
Available
Not available
Animal health and behavior
Ill appearing
Neurologic signs
Aggression
Hypersalivation
Animal vaccination status
Documented current
Unknown
Unvaccinated
Regional rabies epidemiology
Known local rabies activity
Unknown local rabies activity
Prior rabies vaccination status
Completed pre exposure series
Completed post exposure series
Never vaccinated
Infection prevention history
Immunization status
Tetanus vaccine date
Up to date within 5 years
Up to date within 10 years
Unknown or more than 10 years
Prior tetanus immune globulin
Yes
No
Host factors affecting infection risk
Diabetes mellitus (E11.9)
Cirrhosis (K74.60)
Alcohol use disorder (F10.20)
Asplenia (Z90.81)
Immunosuppression
Chronic kidney disease (N18.9)
Associated symptoms
Symptoms after bite
Local
Increasing pain
Erythema
Swelling
Purulence
Lymphangitic streaking
Numbness
Weakness
Reduced range of motion
Systemic
Fever
Chills
Malaise
Nausea
Allergy and toxin
Urticaria
Wheeze
Angioedema
Dizziness
Concerning for rabies
Paresthesia at wound
Hydrophobia
Aerophobia
Dysphagia
Agitation
Confusion
Alarm Features
Time critical triggers
Immediate escalation triggers
Airway compromise
Facial or neck swelling
Stridor
Shock physiology
Hypotension
Altered mental status
Rapidly progressive soft tissue infection
Pain out of proportion
Skin necrosis
Bullae
Crepitus
Neurovascular compromise
Absent distal pulses
Progressive weakness
Deep space or compartment concern
Severe swelling
Tense compartments
High risk wound patterns
High risk wound features
Hand bite
Flexor tendon sheath pain
Finger held in flexion
Face bite
Lip or eyelid involvement
Through and through oral laceration
Joint involvement
Pain with passive motion
Joint effusion
Open fracture concern
Deformity
Bone exposure
Rabies high risk exposures
Rabies high risk features
Bat exposure
Bite or scratch
Mucosal exposure
Unattended child with bat in room
Sleeping person with bat in room
Intoxicated or cognitively impaired with bat in room
Wild terrestrial carnivore exposure
Raccoon
Skunk
Fox
Animal unavailable for testing or observation
Escaped
Unknown owner
Medications
Current medications relevant to management
Medication reconciliation focus
Anticoagulants
Warfarin
Apixaban
Rivaroxaban
Dabigatran
Antiplatelets
Acetylsalicylic acid
Clopidogrel
Immunosuppressants
Systemic corticosteroids
Calcineurin inhibitors
Antimetabolites
Biologics
Allergies affecting antibiotics
Penicillin allergy
Cephalosporin allergy
Recent antibiotics
Prior beta lactam exposure
Prior MRSA active agent exposure
Rabies biologics considerations
Rabies prophylaxis medication factors
Prior rabies vaccination documentation
Vaccine product if known
Dates if known
Immunocompromised status
Solid organ transplant
Hematologic malignancy
Advanced HIV
Pregnancy
No contraindication to rabies PEP
Obstetric follow up coordination
Diet
Intake and hydration context
Nutrition and hydration factors
Oral intake tolerance
Normal
Reduced
Hydration status indicators
Poor oral intake
Vomiting
Alcohol exposure
Recent heavy use
Chronic use
Review of Systems
Infection and systemic symptoms
Infection ROS
Fever
Chills
Night sweats
Myalgias
Headache
Neuro and cardiopulmonary symptoms
Neuro cardiopulmonary ROS
Paresthesia
Weakness
Confusion
Dyspnea
Wheeze
Chest pain
Palpitations
Local wound and limb symptoms
Wound extremity ROS
Increasing pain
Swelling
Redness
Drainage
Reduced range of motion
Loss of sensation
Loss of strength
Collateral History and Family History
Collateral and exposure verification
Collateral sources
Family or caregiver witness
Animal owner report
Veterinary record access
Public health report
Animal control report
Family and household context
Household context
Other exposed household members
Children or dependent supervision reliability
Household pets vaccination status
Risk Factors
Bite infection risk factors
Infection risk stratification
High risk sites
Hand
Face
Genital
Foot
High risk wound types
Puncture wound
Crush injury
Deep laceration
Delayed presentation
More than 8 hours
More than 24 hours
Host risk factors
Immunocompromised
Diabetes mellitus (E11.9)
Asplenia (Z90.81)
Cirrhosis (K74.60)
Rabies exposure risk factors
Rabies exposure risk stratification
Species risk
Bat
Wild terrestrial carnivore
Dog or cat in rabies endemic region
Exposure severity
Multiple bites
Bites near head and neck
Animal unavailable for assessment
Unable to capture
Unknown animal
Occupational and travel risk
Exposure context risk
Occupational
Veterinarian
Animal handler
Wildlife control
Laboratory exposure
Travel related
Dog bite in rabies endemic region
Limited access to rabies biologics
Differential Diagnosis
Life threatening
Life threatening diagnoses
Necrotizing soft tissue infection (M72.6)
Pain out of proportion
Rapid progression
Sepsis (A41.9)
Fever
Hypotension
Anaphylaxis (T78.2)
Hypotension
Bronchospasm
Rabies (A82.9)
Paresthesia at wound
Hydrophobia
Common
Common diagnoses
Local wound infection
Cellulitis (L03.119)
Abscess (L02.91)
Bite wound without infection
Dog bite (W54.0XXA)
Cat bite (W55.01XA)
Lymphangitis (I89.1)
Streaking erythema
Tender lymph nodes
Less common
Less common diagnoses
Flexor tenosynovitis (M65.9)
Fusiform swelling
Pain with passive extension
Septic arthritis (M00.9)
Joint effusion
Severe pain with motion
Osteomyelitis (M86.9)
Persistent deep pain
Delayed infection after puncture
Capnocytophaga infection
Asplenia (Z90.81)
Sepsis pattern
Pasteurella multocida infection
Rapid onset within 24 hours
Cat bites
Bartonella henselae
Cat scratch disease (A28.1)
Regional lymphadenopathy
Past Medical History
Relevant baseline conditions
Baseline risk conditions
Immunocompromised state
HIV (B20)
Solid organ transplant (Z94.0)
Diabetes mellitus (E11.9)
Prior foot infections
Peripheral neuropathy
Peripheral vascular disease (I73.9)
Poor wound healing history
Prior revascularization
Asplenia (Z90.81)
Prior severe infections
Vaccination history relevance
Prior bite and vaccine history
Prior related history
Prior bite infections
Prior hospitalization
Prior MRSA infection
Rabies vaccination history
Prior pre exposure prophylaxis
Prior post exposure prophylaxis
Tetanus immunization history
Primary series completed
Booster intervals
Physical Exam
General and vital signs
Global assessment
Toxic appearance
Hemodynamic status
Tachycardia
Hypotension
Temperature pattern
Fever
Hypothermia
Wound and extremity exam
Wound focused exam
Wound inspection
Location
Depth
Devitalized tissue
Purulence
Foreign body
Surrounding tissue
Erythema margins
Warmth
Induration
Crepitus
Neurovascular exam distal to wound
Sensation
Motor function
Capillary refill
Pulses
Range of motion
Active range
Passive range
Hand specific
Kanavel signs cluster
Thenar or hypothenar swelling
Joint involvement screening
Pain with axial loading
Effusion
Head and neck exam when relevant
Head and neck injury exam
Facial nerve function
Oral cavity lacerations
Ocular injury screening
Visual acuity change
Globe injury concern
Lab Studies
Infection and sepsis evaluation
Labs for suspected infection
CBC
Leukocytosis support
Neutropenia risk
CRP
Trend marker
Non specific elevation
Blood cultures
Fever with systemic toxicity
Immunocompromised host
Serum lactate
Sepsis concern
Necrotizing infection concern
Wound microbiology
Microbiology guidance
Wound culture
Purulent drainage present
Deep space infection suspected
Superficial swab limitations
Poor correlation with deep pathogens
Consider aspiration or deep sample
Imaging
Scoring Systems
Exposure classification tools
WHO rabies exposure categories
Category I no exposure
Category II minor exposure
Category III severe exposure
Clinical infection risk flags
Hand bite high complication risk
Cat puncture high infection risk
MRI
MRI indications
Osteomyelitis concern
Persistent deep pain
Poor response to antibiotics
Deep space infection
Tenosynovitis concern
Fasciitis concern
MRI limitations
Availability and time
Motion artifact
CT
CT indications
Face bite deep structure injury
Fracture concern
Foreign body concern
Necrotizing infection evaluation adjunct
Gas in soft tissues
Deep fascial fluid
CT limitations
Radiation exposure
Contrast nephrotoxicity risk
Ultrasound
Ultrasound applications
Soft tissue abscess
Drainable collection
Cellulitis cobblestoning
Retained foreign body
Tooth fragment
Wood or plastic
Ultrasound limitations
Operator dependence
Limited deep space evaluation
Special Tests
Rabies animal testing and public health interface
Rabies testing pathway
Animal capture and testing coordination
Public health notification
Animal control coordination
Specimen handling precautions
Avoid aerosol generating manipulation
Use trained personnel
Procedural bedside assessments
Bedside procedural tests
Saline load test for joint violation
Consider for periarticular wounds
Orthopedics consultation alignment
Tendon injury assessment
Isolated tendon testing
Wound exploration with anesthesia
ECG
Indications and high risk patterns
ECG use cases
Anaphylaxis with hypotension
Tachyarrhythmia evaluation
Ischemia in older patients
Severe sepsis physiology
Demand ischemia patterns
Electrolyte disturbance clues
Assessment
Working problems
Problem list synthesis
Bite wound
Dog bite (W54.0XXA)
Cat bite (W55.01XA)
Rabies exposure risk
Contact with and exposure to rabies (Z20.3)
Need for immunization (Z23)
Wound infection status
No infection
Local infection
Systemic infection
Severity and complication risk
Risk stratification summary
Rabies risk level
High risk species or scenario
Animal unavailable
Infection complication risk
Hand bite
Puncture wound
Immunocompromised host
Structural injury risk
Tendon involvement
Joint involvement
Fracture concern
Plan
First 5 minutes and stabilization
Immediate priorities
Airway and breathing
Oxygen for hypoxemia
Anaphylaxis protocol if airway symptoms
Circulation
IV access for systemic toxicity
Fluid resuscitation for shock
Analgesia
Acetaminophen PO 650 mg
Ibuprofen PO 400 mg
Time critical consult triggers
Hand surgery for tendon sheath concern
ENT or plastics for complex facial injury
Wound care and closure strategy
Wound management
Irrigation
High volume saline irrigation
Pressure irrigation for contaminated wounds
Debridement
Remove devitalized tissue
Remove foreign bodies
Exploration
Evaluate tendon and joint capsule involvement
Evaluate neurovascular injury
Closure approach
Primary closure options
Face wounds with good irrigation
Low infection risk lacerations
Avoid primary closure scenarios
Puncture wounds
Hand wounds high infection risk
Grossly contaminated wounds
Antibiotics
Antibiotic strategy
Prophylaxis indications
Hand bite
Deep puncture
Crush injury
Delayed presentation more than 8 hours
Immunocompromised host
Treatment indications
Cellulitis
Abscess
Lymphangitis
First line oral
Amoxicillin clavulanate
Adult 875 mg 125 mg PO twice daily
Prophylaxis duration 3 to 5 days
Treatment duration 5 to 7 days
Penicillin allergy options
Doxycycline
Adult 100 mg PO twice daily
Avoid in pregnancy
Avoid in children under 8 years
Metronidazole
Adult 500 mg PO twice daily
TMP SMX
Adult 160 mg 800 mg PO twice daily
Clindamycin
Adult 300 mg PO three times daily
Pediatric examples
Amoxicillin clavulanate
Amoxicillin component 25 to 45 mg per kg per day divided twice daily
Maximum per local pediatric protocol
TMP SMX plus clindamycin
TMP component 4 to 5 mg per kg per dose twice daily
Clindamycin 10 mg per kg per dose three times daily
IV antibiotics indications
Systemic toxicity
Rapid progression
Deep space infection
Tetanus prophylaxis
Tetanus prevention
Vaccine indications
Unknown or incomplete immunization
More than 10 years since booster
More than 5 years since booster for contaminated wounds
Tetanus immune globulin indications
Dirty wound with unknown or incomplete immunization
Severe immunodeficiency with dirty wound
Administration considerations
Vaccine and immune globulin different sites
Document product and lot if available
Rabies post exposure prophylaxis
Rabies PEP decision and regimen
Immediate wound cleansing
Soap and water irrigation
Virucidal agent if available
Animal observation and testing logic
Dog cat ferret available and healthy
10 day observation local protocol dependent
Unvaccinated regimen
HRIG 20 IU per kg once
Infiltrate as much as feasible into and around wound
Remaining HRIG IM at site distant from vaccine
Rabies vaccine IM series
Day 0
Day 3
Day 7
Day 14
Immunocompromised regimen
Add vaccine dose day 28
Consider serologic confirmation per public health
Previously vaccinated regimen
No HRIG
Rabies vaccine IM
Day 0
Day 3
Administration pearls
Deltoid IM adult
Anterolateral thigh IM child
Avoid gluteal injection
Intradermal regimens
Programmatic option in some settings
Local protocol dependent
Reassessment loop
Reassessment triggers
Pain progression within hours
Expanding erythema
Fever development
New neurologic deficits distal to wound
Reduced range of motion
Return evaluation window 24 to 48 hours for high risk wounds
Disposition
Level of care decision
Disposition criteria
ICU criteria
Septic shock
Airway compromise from anaphylaxis
Inpatient admission criteria
Rapidly progressive infection
Deep space infection
Need for IV antibiotics
Infected hand bite with functional compromise
Observation pathway criteria
High risk wound needing serial exams
Significant swelling without clear deep infection
Discharge criteria
No systemic toxicity
Adequate irrigation completed
Neurovascularly intact distal exam
Reliable follow up and vaccine access if needed
Follow up coordination
Follow up plan
Wound check timing
24 to 48 hours for hand bites and punctures
48 to 72 hours for other high risk wounds
Rabies vaccine schedule follow up
Day 3 appointment
Day 7 appointment
Day 14 appointment
Public health coordination
Documentation of exposure and plan
Animal control case number if applicable
Discharge Instructions
Copy discharge instructions
Patient instructions
Wound care
Keep wound clean and dry for 24 hours
Daily gentle washing with soap and water after 24 hours
Apply clean dressing daily
Medications
Take antibiotics exactly as prescribed if provided
Pain control with acetaminophen or ibuprofen as directed
Rabies vaccines if started
Return for scheduled vaccine doses on day 3 day 7 day 14
Do not miss doses
Return to emergency care now for
Fever
Spreading redness
Increasing swelling
Pus or foul drainage
Severe pain
Numbness or weakness
Trouble moving fingers or joints
Red streaks up the arm or leg
Trouble breathing or swelling of lips or face
Follow up
See clinician for wound recheck within 24 to 48 hours if high risk wound
Contact public health or animal control if animal is found after discharge
References
Guidelines and key references
Core references
CDC MMWR Human Rabies Prevention United States 2008
CDC MMWR Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies 2022
WHO Rabies vaccines position paper April 2018 Weekly Epidemiological Record
Public Health Agency of Canada Canadian Immunization Guide Rabies vaccine updated 2025
NICE guideline NG184 Human and animal bites antimicrobial prescribing 2020
IDSA Clinical Practice Guideline for Skin and Soft Tissue Infections 2014
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.