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Richard Choi (@rkchoi) for thoughtful comments on this chapter

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The specialties of the 42 panelists in survey 2 were as follows: n = 16 internal medicine, n = 7 neurology, n = 6 other medical specialists, n = 11 researchers in the B12 field, and n = 2 people with medical backgrounds working in B12-related societies or groups (Figure S2)

Prodrome During prodrome, early, flu-like symptoms occur, including: a fever of 100.4F (38C) or above headache anxiety feeling generally unwell sore throat and a cough nausea and vomiting discomfort at the site of the bite Acute neurologic period During this stage, neurologic symptoms develop, including: confusion and aggression partial paralysis involuntary muscle twitching rigid neck muscles convulsions hyperventilation and difficulty breathing hypersalivation, or producing a lot of saliva frothing at the mouth fear of water, or hydrophobia hallucinations, nightmares, and insomnia priapism, or permanent erection, in males photophobia, or a fear of light Toward the end of this phase, breathing becomes rapid and inconsistent