This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 10 of season 1, called Histories, a homeless woman named Victoria arrives at the hospital after being found in a rave party. She presents with a seizure, hand twitches, a fever, a fear of light and water and insensitivity to touch in an area on her body. Combining the clues the team arrive at the conclusion that she has rabies.

Danger level: High

What is it?

Rabies is an infection caused by a virus, which affects the brain and the spinal cord.

Who gets it?

Since, as you’ll read here, there’s a vaccine for rabies, nowadays humans are rarely affected in developed countries. In the US, between 1980-2003 there were about 40 cases of human rabies. In the rest of the world, unfortunately, there are many more human infections – as many as 55,000 people die of rabies each year. 56% of them in Asia and 44% in Africa.

What causes it?

The rabies virus can infect animals such as bats, raccoons, skunks, dogs, foxes, and coyotes. The virus then lives in the animal’s saliva and is transmitted through biting or scratching.

In the US it is usually spread by bats. In other countries, stray dogs are more commonly the cause of infection.

The infected animal will behave weird – it may act shy although it’s usually friendly, or have no fear of humans when it’s wild. It may also drool, foam at the mouth, or show signs of paralysis. When the infected animal bites or scratches a human, the virus can be transferred and infection occurs. The risk of getting rabies is greater if the person is bitten more than one time, or if the bite is close to or on the head.

A dog with rabies.

How does it feel?

The first symptoms look as if you have the flu – they contain fever, cough or a sore throat. Later other symptoms appear, including agitation, anxiety, confusion, difficulty swallowing, excessive salivation, fear of water (called hydrophobia – it’s caused because of the difficulty in swallowing), hallucinations, trouble sleeping, partial paralysis. And eventually, coma and death.

It’s important to note that once symptoms appear, it’s too late for a cure. Still, you have time from the bite to get a cure – the time from exposure to the virus until symptoms appear is usually 2-3 months (although in rare cases it may be shorter or longer).

How is it discovered?

Although there are ways to make sure someone bitten has rabies, the doctor comes at the conclusion you have rabies by the story, since no time can be wasted.

The virus can be discovered by taking a sample of saliva, of spinal fluid, or of tissue from our nervous system. Although a blood test can also discover rabies, it’s usually only positive later in the disease.

How is it treated?

Wound cleansing and immunization done as soon as possible after a contact with an animal can prevent the onset of the disease in virtually 100% of cases.

If you think you’ve been exposed to rabies, first wash the animal bite or scratch with soap and water. Then call your doctor and local health department right away.

Then comes decision time:

• If the animal that beat you has a low chance for having rabies (such as a pet) – The animal will be captured and watched for signs of rabies. At that time the doctor may not want to wait until symptoms appear in the animal and you may get a series of shots against rabies.
• If the animal has a high chance for having rabies (such as a bat or a wild or stray animal) you will start getting the shots right away. If possible, the animal will be watched for signs of rabies or will be killed for testing. If the animal is found to not have rabies, you can stop getting the shots.

What happens after treatment?

As mentioned above, the disease is curable if treated on time. If, on the other hand, no treatment is given, it is nearly always deadly.

There are a few things you can do to prevent rabies:

• Have your pet dog, cat, or ferret, vaccinated against rabies.
• Avoid any contact with bats.
• Don’t touch or pet wild animals (such as raccoons, skunks, foxes, coyotes).
• Don’t handle a dead animal.

What next?

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