- Bite from infected animal→ skunk, bat, squirrel, dog
- Travel to areas when animals unvaccinated, bite by wild animal
- Incubation can be days to mos→ time to travel along pns to cns
- F, ha, myalgias, arthralgias
- Intermitent confusion/agitation
- Sensitivity to sound/light
- Pain at bite site
- Autonomic dysfxn
- 20% w/progressive flaccid paralysis, starting near bite
- Sx onset to death avg 4d
- Confusion/agitation
- Autonomic instability
- Progressive paralysis