SHWA GRAHA (RABIES)

DR. RANI KHANDELWAL

MD IIND YEAR
SHWA GRAHA

• श्वग्रह इस बालग्रह का वर्णन मात्र वाग्भट ने किया है—

'कम्पो हृषितरौमत्वं स्वेदश्चक्षुर्निमीलनम् । बहिरायामनं जिह्वादंशोऽन्तःकण्ठकू जनम् । धावनं विट्सगन्धत्वं क्रोशनं च श्ववच्छु नि'
।। (अ.हृ.उ. 3:15-16)

• कम्पन, रोमाञ्चता, स्वेद, नेत्रों का बन्द होना, बहिरायाम, जिह्वा को काट लेना, गले के अन्दर शब्द होना, दौड़ना, मलवत्
गन्ध एवं कु त्ते के समान चिल्लाना इस बालग्रह के लक्षण हैं
SHWA GRAHA

• मांसपेशियों में ऐंठन एवं

• कम्पन
• बहिरायमान (Qpisthotonus) होना,
• कण्ठकू जन एवं
• कु त्ते के समान चिल्लाना विशिष्ट लक्षण
• दौड़ना एवं जिह्वादंश लक्षण भी विचारणीय हैं। वस्तुतः विभिन्न पेशियों में ऐंठन ही इन सभी लक्षणों का कारण है। यह ऐंठन
Tetany या Tetanus में होती अवश्य है, पर कु त्ते के समान चिल्लाना, दौड़ना आदि लक्षण इसे Rabis के समकक्ष
सिद्ध करते हैं।
SHWA GRAHA MANAGEMENT

• व्रणस्थल को गर्म घृत में जला दें तथा आक का दूध व्रणपर लगा दें ।
(1) शिरीषबीज को थूहर-दुग्ध के साथ पीस कर व्रणस्थान पर लेप करें। इससे कु त्ते का विष नष्ट होता है ।
(2) चावलों को पीस कर उसके मध्य मेषलोम रख कर निगल जाने से कु त्ते का विष नष्ट होता है।
(3) धतूरे के पत्र एवं गूलर फल को चावल की धोवन के साथ पीसकर पीने से कु त्ते का विष नष्ट होता है ।
(4) धत्तूरे के पत्रस्वरस घृत, गुड़, दुग्ध - इन्हें 1 पल की मात्रा में मिश्रित कर पिलाने से कु त्ते का विष नष्ट होता है ।
(5) अपराजितामूल सर्वविषनाशक है । (भै.र.वि.चि. 72:43-45)
(6)भीमरुद्रो रस (भै.र.वि.चि. 72:53-56) विषवज्रपातो रस (भै.र.वि.चि. 72:57-58) आदि का प्रयोग करें ।
RABIES

Rabies is a zoonotic disease caused by Lyssavirus transmitted to human beings by

bites from rabid animals. It is almost always fatal but can be prevented by timely
initiation of post-exposure prophylaxis (PEP). Like cleaning wound or
administration of RIGs
Rabies is transmitted to humans largely by dogs and cats (>97%). Wild animals
(2%) such as mongoose, foxes, jackals, wild dogs, wild rodents, and occasionally
by monkeys, horses, donkeys, and others. Domestic rats, rabbits, and birds are
ordinarily not known to transmit rabies.
RABIES PATHOPHYSIOLOGY
Rabies virus is neurotropic; virus enters the peripheral nerves or cranial nerves
from the damaged nerve endings from the site of bite (fig)

ascend up through dorsal route ganglion, spinal cord,

finally reaches brain where it multiply enormously.

The rabies virus subsequently descends down to all secretory glands, viz., salivary
glands, mammary glands, sweat glands, and urine via sympathetic nervous
system.
RABIES PATHOPHYSIOLOGY

• Hence, although all secretions of rabid patients are infectious, no human-to-

human transmission has been reported.

• After an average incubation period of 30–90 days, a clinical symptom of

hydrophobia occurs.
• There are two forms of rabies in man:
1. Classic hydrophobia: Hydrophobia, aerophobia, and photophobia—clinical
course about 1 week to 10 days. More remarkable abnormalities (agitation,
photophobia, insomnia, nightmares, and depression) may also occur.
2. Paralytic rabies: Ascending paralysis—clinical course about 3 weeks; death
invariably occurs due to cardiorespiratory failure.
STAGES OF ONSET OF RABIES
1. First stage :
• Burning, redness, pain,
• feeling of coolness and
• ant crawling sensation on cut site.
• symptoms of restlessness
• black spot in the eye,
• excessive redness in eyes
• insomnia,
• depression, etc.
• This condition lasts for 2-3 days.
STAGES OF ONSET OF RABIES
2. Second stage –
• Excitement increases
• Delirium,
• muscle cramps
• mild convulsions begin to occur.
• acute painful contraction in the muscles of the throat when infected person see or wants to
take food or fluid.
• Low level noise also increases this contraction .
• There is difficulty in breathing.
• Tonic convulsions and death also occur.
• Temperature from 103 to 106 ° F.
• This stage is also 2-3 days.
STAGES OF ONSET OF RABIES

3. Third stage-
• The nerves begin to degenerate.
• The cramps gradually decrease
• followed by gradual complete paralysis.
• Then the fainting and death occurs in 1-2 days
PROPHYLAXIS OF RABIES

Human rabies is almost always fatal after an animal bites, it can be

prevented either by
(1) pre-exposure prophylaxis (PrEP)
(2) post-exposure prophylaxis (PEP).
PRE EXPOSURE PROPHYLAXIS OF RABIES

• Pre-exposure prophylaxis is recommended for individuals at higher risk due to

occupation and for the children in endemic countries like India. Rabies vaccines
can be administered by two different routes:
• intradermal (ID) or intramuscular (IM), and according to different schedules.
• For young children (aged < 2 yr) :- anterolateral area of the thigh ;
• IM regimen: One dose of vaccine on days 0, 7, and 21/28 - anterolateral aspect
of thigh/deltoid region (for adults.)
• ID: 0.1 mL of vaccine on days 0–7–21 or 28 - deltoid region/anterolateral thigh.
• Two-site ID administration of rabies vaccine has also been recommended on
day 0 and 7.
POST EXPOSUREPROPHYLAXIS OF RABIES
In patients previously not taken any rabies vaccine
Assessment of risk by categorization of wounds:
Category Type of contact Type of exposure Recommended PEP

I  Touching/feeding None None, if reliable history is

animals available
 Licks on intact skin
II  Nibbling of uncovered Minor • Local treatment of
skin wounds
 Minor • Administer anti-rabies
scratches/abrasions vaccine
without bleeding
III  Sigle/multiple Severe • Local treatment of
transdermal wounds
bites/scratches • Administer of RIG/RMab
 Licks on broken skin • Anti rabies vaccine
 Contamination of
mucous memebrane
with saliva (licks)
POST EXPOSUREPROPHYLAXIS OF RABIES
RABIES VACCINATION

• Administration of anti-rabies vaccine:

Currently available rabies vaccine recommended for children in India are of two
types:
1. Purified chick embryo cell rabies vaccine (PCECV) .
2. Purified Vero cell rabies vaccine (PVRV)

Rabies vaccine for PEP can be administered either by

• Intramuscular route: One dose of vaccine administered on days 0–3–7–14–28
(1–1–1–1–1) . Given in the deltoid region or, for young children, into the antero-
lateral area of the thigh muscle
RABIES VACCINATION

• \The 2-1-1 regimen: (2-0-1-0-1) •

• Two doses are given on day 0 in the deltoid muscle, right and left arm
• • An additional one dose is administered in the deltoid muscle on day 7 and day
21
• Intradermal route: 0.1 mL × 2 sites on days 0–3–7–28 (2–2–2–0–2)
Site: Anterolateral thigh or deltoid
RIGS/RMABS
Administration of RIGs/RMAbs (passive immunization)
• For individuals with category III (severe) exposures, vaccine alone is not
enough and additionally RIG/RMAbs is indicated as vaccine induced antibodies
appear only after 7–14 days.
• During this window period of 7–14 days, patient is unprotected, hence,
RIG/RMAbs need to be administered.

• There are two classes of rabies passive immunizing agents:

• 1. Rabies immunoglobulins (RIGs) :
• i. Equine rabies immunoglobulin (ERIG) ii. Human rabies immunoglobulin
(HRIG)
RIGS/RMABS

2. Rabies monoclonal antibody (Rmab)

i. Human RMAb (single Mab—rabishieldTM)
ii. Cocktail of RMAbs (Docaravimab and Miromavimab-TwinrabTM)