psychological basis of hydrophobia and aerophobia in rabies

Q: What is the psychological basis of hydrophobia and aerophobia in rabies?

Answer: Fear of pharyngeal muscle spasms

Hydrophobia is more common than aerophobia. Other clinical symptoms of rabies include fever, pharyngeal spasms, and hyperactivity, progressing to paralysis, coma, and death.

Hydrophobia, first described in 1900 (see reference # 1), is the most characteristic clinical sign of rabies. It begins as feeling of discomfort in the throat or dysphagia. Patient develops an overwhelming terror of water based on involuntary pharyngeal muscle spasms during attempts to drink, which proceeds even to the sight or mention of water.

Aerophobia occurs less frequently and is also pathognomonic of rabies. A draft of air causes pharyngeal spasms lasting a few seconds. This may also be associated with painful inspiratory spasms of the diaphragm and accessory inspiratory muscles. Symptoms include coughing, choking, vomiting, and hiccups, followed by asphyxiation and respiratory arrest.

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References:

1. D.E. Salmon: Rabies and Hydrophobia - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9346709/pdf/jcmvetarch131802-0015.pdf

2. Hemachudha T, Laothamatas J, Rupprecht CE. Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges. Lancet Neurol 2002; 1:101.

3. Tongavelona JR, Rakotoarivelo RA, Andriamandimby FS. Hydrophobia of human rabies. Clin Case Rep. 2018 Oct 18;6(12):2519-2520. doi: 10.1002/ccr3.1846. PMID: 30564365; PMCID: PMC6293146.

4. Bleck TP, Rupprecht CE. Rhabdoviruses. In: Principles and Practice of Infectious Diseases, Sixth Ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005. p.2047.