Effects of papaya leaves on thrombocyte counts in dengue

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Effects of papaya leaves on thrombocyte counts in dengue - a case repo= rt

Pages with reference to book, From 364 To 366

Osama Siddique, Ayesha Sundus=C2=A0 ( Student, Dow University of Health Sciences, Karachi. )=
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Mohammad Faisal Ibrahim=C2=A0 ( Civil Hospital Karachi. )
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Abstract

Dengue fever is on the ris= e in developing nations like India, Pakistan, Sri Lanka and Bangladesh. The= re is no anti-viral chemotherapy or vaccine for dengue virus and management= of the disease is done on supportive measures. The decline in the thromboc= yte count leads to dengue haemorrhagic fever accounting for complications= and mortality. Oral administration of Carica papaya leaves extract is said= to have a positive impact on thrombocyte count. A 23-year-old man was admi= nistered a calculated dose for five days. Blood samples were tested for com= plete blood count before and after the administration of the juice. Thrombo= cyte count had increased from 28000/micro liter to 138000/micro liter at th= e end of five days. We present our experience here.
Keywords: Dengue fever, Thrombocyte count, Carica papaya leaves.

Introduction

Carica papaya L. is the on= ly species within the Caricaceae genus, and the palm-like tree has segmente= d leaves, yellow flowers and large black seeded yellow to orange fruits.1 C. papaya L. fruit juice and leaves extracts have demonstrated an= ti-cancer,² anti-oxidative,³ anti-inflammatory,⁴⁼ anti-bacterial,⁵ nephro-protective,⁶ hepato-pr= otective⁷ activity against toxins, hypoglycaemic, hypolipidaemic= effects⁸ and anti-sickling properties in sickle cell disease.9
Dengue fever (flaviviridae family of viruses) is an arthropod-borne disease= carried by Aedes ayegypti with four different serotypes 1, 2, 3 and 4.10= Dengue fever cases have been on the rise in Pakistan and other developing= countries. It is estimated that there are between 50 and 100 million cases= of dengue fever (DF) and about 500,000 cases of dengue haemorrhagic fever= (DHF) each year which require hospitalisation.¹⁰ There is no kn= own anti-viral chemotherapy for DF yet. Many vaccine trials have been done,= but none has produced a satisfactory outcome.¹⁰ Management incl= udes supportive measures like anti-pyretic, hydration, blood and blood prod= ucts and pain killers. Infection induces a life-long immunity to that parti= cular serotype, but secondary infection with another serotype is dangerous= and life-threatening due to higher risks of DHF.¹¹ The only way= to prevent dengue virus acquisition is to avoid being bitten by a vector= mosquito.¹⁰
With such high rates of incidence and mortality it would be useful to have= a regimen improving the outcome of the disease. Investigating the effect= of papaya leaves on the platelets can help our physicians in helping patie= nts with diseases like DF where the platelets are the major cause of compli= cations and mortality. Here we present a DF case who responded positively= to the administration of papaya leaves extract.

Case Report

A 23-year-old male, medica= l student by profession, a swimmer by hobby and a resident of Karachi was= brought to Sunset Poly Clinic with a fever of 102=C2=B0F for the preceding= 2 days. Symptoms included nausea, red skin, severe body ache and weakness.= He reported that he used to visit friends and poorly managed tea stores af= ter sunset every evening after his swimming sessions. He was bitten by a mo= squito somewhere. After 2 days he had high-grade fever with severe body ach= e, weakness and nausea. The symptoms would increase at some times of the da= y and decrease at other times.
He was admitted and tested for typhoid, malaria and dengue. Dengue Rapid N5= 1 antigen was found to be positive. The haematological reports also reveale= d an abrupt decline in the patient's thrombocyte counts. He was given azith= romycin 250mg once daily, acetaminophen 8-hourly and tremendous amounts of= hydration orally, but there were no signs of improvement and the condition= got worse with time. After obtaining consent from the patient, C. papaya= leaves extract was administered orally to the patient to test the popular= belief of the leaves increasing thrombocyte counts under the supervision= of the senior physician at the clinic. The leaves were collected and thoro= ughly washed with boiled and cooled water. One-and-a-half leaf was ground= in a grinder with water to make a juice of 150ml. As the taste of the C.= papaya leaves is extremely bitter, the patient would have alternate sips= between the C. papaya extract and commercially-made fruit juices. Around= 150ml of extract was given to the patient once daily for five consecutive= days. The extract was given to the patient as a single dose. Platelet coun= t before the administration of extract had been done every day and the rout= ine was followed during the 5 days of extract administration as well.
Haematological assessment revealed that platelets and white blood cells sho= wed continuous decrease with a slight decrease in haemoglobin initially (Ta= ble-1).
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The results of the 5 days after= the leaves extract was given improved manifold (Table-2).
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The family was warned about platelet transfusions if re= quired and the patient was kept on fluid diet with intravenous hydration.= The patient remained in the hospital throughout the 10 days of treatment.<= br> With every successive administration of the extract, the reports revealed= a continuous rise in platelets; a rise from 28000/micro liter to 138000/mi= cro liter by the end of the fifth day of taking the C. papaya leaves extrac= t.
Amongst the clinical signs and symptoms, fever, body ache and nausea also= resolved with the therapy.

Discussion

The main objective was to= investigate the role of Carica papaya leaves in DF. A toxicity study (acut= e, sub-acute, and chronic toxicity) conducted on Sprague Dawley rats admini= stered with Carica papaya leaves juice (CPLJ) of the sekaki variant reveale= d that it was safe for oral consumption.¹² There are no anti-vir= al chemotherapeutic agents yet discovered for DF. The journey to drug disco= very through the study of immune-modulatory effects against dengue infectio= n is based on the research of generic compounds and natural products.^1=
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C. papaya L. has been used for centuries in ethno-medicine to treat many di= seases and symptoms, and mature ripe fruits have been used as an effective= remedy against ringworms.¹⁴ Green fruits, on the other hand, ha= ve been used to lower blood pressure, and as an aphrodisiac. C. papaya Leav= es were eaten and used as a heart tonic and analgesic. In traditional medic= ine, they were used to reduce inflammation and pain due to their analgesic= properties.¹⁴ We further investigated their role in DF and effe= cts on thormbocyte counts.
Our investigation revealed positive findings in the role of C. papaya leave= s for the treatment of dengue, and for improving platelet counts. This was= also observed in another study on a 45-year-old man where counts increased= from 55000/micro liter to 168000/micro liter.¹⁵ Our study showe= d a dramatic increase in thrombocyte count from 28000/micro liter to 138000= /micro liter within 5 consecutive days of administration. This is further= supported by another study in which the PTAFR gene, which is known to be= responsible for increased platelet production and aggregation, was express= ed 13.42-folds among the patients who consumed the papaya juice as compared= to the control group, indicating that the juice had played an important ro= le in addressing the arresting of bleeding tendencies among these patients.= ¹⁶
Our study further depicted the improvement in the symptoms of dengue during= and following the administration of the extract. Along with the increasing= thrombocyte counts, the anti-hemolytic action of C. papaya leaves could ha= ve a potential therapeutic efficacy in the disease processes, causing desta= bilisation of biological membranes.¹⁷
The patient's recovery and progressive increase in thrombocyte counts could= have been spontaneous since DF is a self-limiting disease with sufficient= supportive therapy. This factor can be investigated in a further study usi= ng controls.
Plants are a useful source of medicine and C. papaya is one of them. Our st= udy supports the popular claim of the use of C. papaya leaves in treating= DF by increasing platelet counts and alleviating symptoms.

Conclusion

Dengue is on the rise agai= n in our part of the world and better understanding of the management of de= ngue is important to avoid dengue haemorrhagic fever. C. papaya leaves seem= s to be a promising solution to our problem. Dengue fever continues to be= a nuisance, causing several deaths every year, and a further detailed stud= y on investigating this topic might help in reducing the associated mortali= ty.

Acknowledgements

We are grateful to our pat= ient and his family for allowing us to proceed with the study, and to Dr.= Khalid Azam, who permitted and supervised the administration of the extrac= t to the patient.

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