4. निदाि
(Cause of अलर्
क विष)
1
• When vata gets aggravated in the body of dog, fox, jackal,
hyena, bear, tiger etc,
• combines with the aggravated kapha
2
• Accumulates in the channels of their
sense organs
3
•Causes loss of sensation or
hampers the consciousness
5. Signs and Symptoms in the Animal Affected
प्रसस्त लाङ् गूल hanging its tail
हिु drooping down of lower jaw
स्कन्ध drooping of its shoulders
अनिलालवाि् copious flow of saliva from the mouth
अत्यर्थ बनिर animal is intensely deaf
अत्यर्थ अंि animal is intensely blind
अन्योन्यमनििावनि animal moves here and there
6. अलर्
थ नवष लक्षण
(Features of Rabies Poison )
1. सामान्य लक्षण
2. सविष दृंश लक्षण & वनविकष दृंश लक्षण
3. असाध्य लक्षण
7. सामान्य लक्षण
देशस्तेि नवदष्टस्य सुप्तः र्
ृ ष्ण क्षरत्यसृर्
् ।
हच्छिरोरुर्
् ज्वर स्तम्भ िृष्णा मृिोंद्धव अिु च।।
(अ.सं.३. ४६/१२)
Bitten by a rabid dog the person develops :
loss of sensation at the bite site
black coloured blood comes out from the site of bite
he develops pain in the heart and head
fever
Rigidity
thirst
fainting
8. सनवष दंश लक्षण & निनवथष दंश लक्षण
1. र्ण्ड
ू -Itching
2. वनस्तोद-Pain
3. िैिर्ण्क- Discoloration
4. क्लेद-exudation
5. ज्वर[-fever
6. विदाह-burning sensation in the abdomen
7. राग-site of bite becomes red
8. रुर्-pain
9. पार्-suppuration
10.शोफ-swelling
11.देशािदरण-contractures
12.मण्डल-development of round patches
13.स्फोट-tearing and falling of muscles development of round patches
14.र्वणकर्ा-development of swelling like lotus seed
The bites without above symptoms are said to be निनवथष दंश लक्षण.
9. असाध्य लक्षण
दष्टो येि िु िच्चेष्टा रुिं र्
ु वथि् नविश्यनि ।
पश्यंस्तमेव च अर्स्मादादशथ सनललानदषु ।।
The person bitten by a rabid animal imitates the
animal in actions and voice, sees them in
mirrors, water etc without any reason and finally
dies.
10. जलसंत्रास (Hydrophobia)
• The condition called jalasantrasa is explained which is
also an asadhya lakshana of alarka visha.
• त्रस्यनि अर्स्माि् यो अिीक्ष्णं दृष्ट्वा स्पृष्ट्वा आनप वा जलम्।
जलत्रासं िु नवद्यासं ररष्ट िदनप र्ीनिथिम्।। (सु.फ. ७/४८)
When the person bitten by a rabid dog becomes afraid even by seeing
or touching water without any cause, the condition is called
as Jalasantrasa which is to be considered as fatal.
• जलदशथि संस्पशथ शब्देभ्यो यश्च सन्वसेि्। अदृष्टमनप िं
जाज्जल सन्त्रास रोनगणम्।। (अ.सं.उ. ४६/१७)
He who gets frightened by the sight, touch and sound of
water, should be considered as a patient of jalasantrasa
which is a fatal sign.
11.
12. अलर्
थ नवष नचनर्त्सा
१. नवस्रावण/ रक्तमोक्षण :The blood should
be removed from bite site.
२. दहिःThe site of bite should be burnt with
hot ghee.
३. प्रदेहः Agada is applied as warm poultice
on the bite site.
४. पुराण सनपथ पािःLater, patient is to be
made to drink old ghee.
13. ५. लेपः Roots of nala macerated with water
is beneficial for pana and lepa.
६.शोिि / नवरेचिःPatient should be
administered a purgative drug along with
milky sap of arka.“
७.िस्य अञ्जि- लेप- पाि: Lasuna, ushana,
vaidehi and vara macerated with ox bile is
used for nasya, anjana, lepa and pana.
14. शरपुङ् ख प्रयोग
(Sharpunkha Prayoga)
This is a special treatment explained for alarka
visha.
1. Root of sharapunkha -1 र्षक
2. Root of धत्तूर -1/2 र्षक
3. तण्डुल (Rice) -as required
All above are Macerated with required quantity
of tandulodaka and paste is prepared.
15. Procedure:
• This ball of paste is enveloped with leaves of dhatura
and aapoopa or pan cake is prepared out of it. This
aapoopa is to be consumed at the time of meals (mid-
day) by the person suffering from poison of rabid dog
for complete nullification of the poison.
• The use of these cakes may cause some other
complications at the time of its digestion which should
be subdued by retiring the patient to a dry and cool
chamber away from water. After the symptoms
subsides, the patient should be given bath the next day,
he must be made to take warm meals of shashtika shali
along with milk.
• This treatment should be done for 3 or 5 days with half
the quantity of mentioned drugs.
16. Snana Vidhi
One hundred and eight pots are filled with water,
precious gems and potent herbs. A place near a river,
meeting of four roads or a sacrificial ground, of the size
of a cow's hide is selected, cleaned, washed with cow
dung water and covered with kusha grass. The pots are
placed on this place, decorated with garlands and their
mouth covered.
Fire is lit near by, the pots are sanctified with holy hymns
108 times. The person bitten by rabid dog is then given a
ceremonial bath with water in the pots, chanting hymns.
Shodhana
After snana vidhi, the person should be administered
with strong purificatory therapies because in a person
who is not purified well, the alarka visha gets aggravated
again, though the wound has healed.
18. INTRODUCTION
• Rabies is caused by Lyssa Virus.
• It is spread when an infected animal
scratches or bites another animal or
human.
• Saliva from an infected animal can also
transmit rabies if the saliva comes into
contact with the eyes, mouth, or nose,
treatment is almost never effective and
mortality is over 99%
19. Rabies Progresses in Five Distinct
Stages:
1. Incubation
2. Prodrome
3. Acute Neurologic period
4. Coma
5. Death
20. Incubation Period:
• This is the time before symptoms appear.
• The incubation period is typically 1-3 months in
humans.
• Incubation periods as short as four days and
longer than six years have been documented,
depending on the location and severity of the
contaminated wound and the amount of virus
introduced.
• The closer the bite is to the brain, the sooner
the effects are likely to appear.
21. Prodrome:
Early, flu-like symptoms including:
• A fever of 100.4°F/38°C or above.
• Headache
• Anxiety
• Feeling generally unwell
• Sore throat and a cough
• Nausea and vomiting
• Discomfort may occur at the site of the bite
These can last from 2 to 10 days, and they worsen over
time.
22. Acute Neurologic Period:
Neurologic symptoms develop, including:
• Confusion and aggression
• Partial paralysis, involuntary muscle twitching, and rigid neck muscles
• Convulsions
• Hyperventilation and difficulty in breathing
• Hypersalivation or producing a lot of saliva, and possibly frothing at the
mouth
• Fear of water, or hydrophobia, due to difficulty in swallowing
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.
23. Coma and Death
• If the person enters a coma,death will occur
within a matter of hours,unless they are
attached to a ventilator.
24. HYDROPHOBIA
• It is the historic name for rabies
• It refers to a set of symptoms in the later stages of an
infection in which the person has difficulty in swallowing,
shows panic when presented with liquids to drink, and
cannot quench their thirst.
• Any mammal infected with the virus may demonstrate
hydrophobia.
• Saliva production is greatly increased, and attempts to
drink, or even the intention or suggestion of drinking, may
cause excruciatingly painful spasms of the muscles in the
throat and larynx
• This can be attributed to the fact that the virus multiplies
and assimilates in the salivary glands of the infected
animal with the effect of further transmission through
biting.
• The ability to transmit the virus would decrease
significantly if the infected individual could swallow saliva
and water.
26. Pre Exposure Prophylaxis
• Human rabies vaccines exist for pre-exposure
immunization.
• Pre-exposure vaccination may be offered to high
risk groups like laboratory staff handling the virus
and infected material, clinicians and persons
attending to human rabies cases, veterinarians,
animal handlers and catchers, wildlife wardens,
quarantine officers and travelers from rabies free
areas to rabies endemic areas.
• The Indian Academy of Pediatrics (IAP) has
recommended pre-exposure prophylaxis of children.
27.
28. Approach to Post Exposure Prophylaxis
1. Management of animal bite wound
2. Passive immunization with Rabies
Immunoglobulin (RIG)
3. Active immunization with Anti-Rabies Vaccines
(ARV)
29. Management of Animal Bite Wound
1. Wound Washing – 15 mins
2. Iodine containing topical preparations.
3. Suturing ❌
4. If unavoidable adequate RIG given .
5. Minimal and loose sutures.
30. Passive Immunization
Types of RIGS:
A. Equine Rabies Immunoglobulin (ERIG):
ERIGG is of heterologous origin produced by hyperimmun-isation of horses.
The dose of ERIG is 40 IU per kg body weight of patient
B. Human Rabies Immunoglobulin (HRIG):
HRIG are of homologous origin and are relatively free from the side effects
encountered in a serum of heterologous origin.
The dose of the HRIG is 20 IU per kg body weight.
31. Administration
• The RIG should be brought to room temperature (25°C to 30°C) before administration to the patient.
• As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around
the wound.
• Multiple needle injections into the wound should be avoided.
• The total recommended dose of RIG must not be exceeded as it may suppress the antibody production
stimulated by the anti-rabies vaccine.
• Rabies immunoglobulin for passive immunization is administered only once. preferably within 24 hours
after the exposure (on day 0 along with the first dose of anti rabies vaccine).
• If RIG was not administered when ARV was begun, it can be administered up to the seventh day after
the administration of the first dose of ARV
• Beyond the seventh day (after 3 doses of vaccine have been administered). RIG is not indicated since
an antibody response to ARV would have occurred and administration of RIG at this stage can supress
the immune response of the patient to the ARV received.
• Rabies Immunoglobulin should never be administered in the same syringe or at the same anatomical
site as vaccine.
• The dose is 0.5 ml of 0.1 percent solution (1 in 1000, 1mg/ml) for adults and 0.01ml/kg body weight
for children, injected subcutaneously or IM.
• RIG must never be given intravenously.
• A full course of ARV should follow thorough wound cleansing and passive immunization.
32. Active Immunization
• The first live attenuated injectable rabies
vaccine, developed by Louis Pasteur and
Emile Roux, was first tested in a human bite
victim in 1885 .
33.
34. Post Exposure Prophylaxis
• Intra-muscular (IM) Regimen:
• A. Cell Culture Vaccines:
1. Human Diploid Cell Vaccine (HDCV)-1 ml
2. Purified Chick Embryo Cell Vaccine (PCECV)-
1ml
3. Purified Vero Cell Rabies Vaccine (PVRV), 0.5ml
and 1ml
• B. Purified Duck Embryo Vaccine (PDEV), Iml
