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CASE REPORT
EFFECT OF PAPAYA LEAF JUICE ON PLATELET AND WBC COUNT IN
DENGUE FEVER: A CASE REPORT
DEEPAK BSR1, GIRISH KJ,2 JADHAV LAKSHMIPRASAD L3 1Postgraduate Scholar, 2Professor, 3Associate Professor and Head, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Thanniruhalla, Hassan-573201, Karnataka, India. Corresponding author email: deepak.ayurveda@gmail.com Access this article online : www.jahm.in Published by Atreya Ayurveda Publications, Ilkal-587125 (India) All rights reserved. Received on: 22/05/2013, Revised on: 29/05/2013, Accepted on: 03/06/2013 Summary:
Dengue fever caused by dengue viruses (dengue 1–4) having Aedes aegypti mosquito as their principal vector, causes symptoms such as sudden onset of fever, headache, retro-orbital pain and back pain along with severe myalgia due to which dengue fever is also known as “break-bone fever.” Laboratory findings include leukopenia, thrombocytopenia and in many cases, serum aminotransferase elevations. dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) may occur as a complication of dengue fever.A pilot study and a randomized controlled trial showed that administration of papaya leaf juice was beneficial in dengue patients in elevating the total white cell counts and platelet counts. Based on this report, a dengue patient with thrombocytopenia and leukopenia was treated in a tertiary Ayurveda hospital. The patient was administered papaya leaf juice in the dose of 25 ml twice daily along with conventional line of management for a period of eight days. There was remarkable improvement in the subjective symptoms and the white blood cell count and platelet count were Keywords: Ayurveda, dengue fever, papaya leaf juice, platelet count, dengue hemorrhagic fever
Introduction:
(tourniquet test, petechiae) or overt bleeding in the absence of underlying causes such as pre- Dengue fever is caused by dengue viruses existing gastrointestinal lesions. DSS, usually (dengue 1–4) having Aedes aegypti mosquito as accompanied by hemorrhagic signs, may result their principal vector. After an incubation period from increased vascular permeability leading to of 2–7 days, the patient typically experiences the sudden onset of fever, headache, retro-orbital DHF/DSS, restlessness, lethargy, thrombo- pain and back pain along with the severe cytopenia and hemo-concentration are detected myalgia due to which dengue fever is also 2–5 days after the onset of typical dengue fever, known as “break-bone fever.” The illness may usually at the time of defervescence.The last a week, usually with additional symptoms maculopapular rash that often develops in like anorexia, nausea or vomiting. Laboratory dengue fever may also appear in DHF/DSS. In findings include leukopenia, thrombo-cytopenia more severe cases, frank shock characterized by and in many cases, serum aminotransferase low pulse pressure, cyanosis, hepatomegaly, elevations. The diagnosis is made by IgM pleural effusions, ascites and in some cases, ELISA; antigen-detection ELISA or RT-PCR severe ecchymoses and gastrointestinal bleeding during the acute phase; paired serology during recovery. Dengue hemorrhagic fever (DHF) or Dengue shock syndrome (DSS) may occur as a complication of dengue fever. DHF is identified complimentary systems of medicine such as Ayurveda for treatment of disorders such as Journal of Ayurveda and Holistic Medicine |July, 2013 | Vol 1 | Issue 3 Deepak BSR, Girish KJ, Jadhav LL: Effect of papaya leaf juice in dengue fever: a case report dengue for which specific treatment is not ampoule IV twice daily; Injection gramocef-1g available.2 In this regard, when the literature was IV twice daily; tablet paracetamol 650mg-one administration of papaya leaf juice proved to be The next day, in addition to the above, papaya beneficial in dengue patients in elevating the leaf juice in the dose of 25ml was advised to be total white cell counts, platelet counts and taken twice daily. The papaya leaf juice was prepared from washed tender leaves after randomized controlled trial demonstrated that deveining them and then grinding in a juice the administration of papaya leaf juice in dengue extractor with small quantity of water. This fever and DHF is safe and induces rapid increase regimen was followed upto seventh day of in platelet count.10 One case, where the administration of papaya leaf juice to a patient On the eighth day, treatment was revised and the of dengue fever in a tertiary Ayurveda hospital patient was advised to take papaya leaf juice in was found to be beneficial, is reported here. the same dosage; syrup balaguduchyadi kashaya Case history:
15 ml thrice daily after food with 15 ml water; A 51 years old male patient reported to the tablet samshamani vati-2 tablets thrice daily Kayachikitsa outpatient department on 11th June after food; tablet septilin-1 tablet thrice daily 2013, with history of fever associated with chills after food. By 19th June, the patient recovered and generalized body ache. On asking about the well and was discharged with the same advice. details of the same, he stated that he was alright till the evening of 4th June 2013 after which he haematological findings is presented in Table 1. developed loss of appetite and nausea. The next Table 1: Effect on clinical & laboratory
day he begot fever with chills, generalized body parameters
ache and weakness. He took treatment from a Complaints
Platelet
WBC
Date
and clinical
nearby doctor but found little relief. After 3 days count
count
findings
he suffered from loose stools and an old pile mass began to bleed during defecation. He had bitter taste sensation in the mouth. He had past medical history of jaundice at the age of 15 and On examination, he was afebrile, had pulse rate of 60/min with good volume and blood pressure of 110/80 mm of Hg. Per abdomen examination revealed tenderness in epigastrium. He was investigations. He tested positive for dengue NS1/IgG-IgM test. Routine blood examination revealed leukopenia (white blood cell count- (platelet count-56,000 cells/cmm). USG scan of abdomen showed acalculous cholecystitis. The same day he was admitted in the inpatient department and the opinion of an allopathic Treatment and results:
From the second day of admission,the patient was advised IV fluids (ringers lactate) in maintenance dose; Injection dexamethasone-1 Journal of Ayurveda and Holistic Medicine | July, 2013 | Vol 1 | Issue 3 Deepak BSR, Girish KJ, Jadhav LL: Effect of papaya leaf juice in dengue fever: a case report Conclusion:
The administration of papaya leaf juice was found to be beneficial in increasing the platelet and white blood cell count in the case of dengue reported. This fact is well established by various (Sample were collected between 8-9am daily) experimental studies and clinical trials cited Discussion:
earlier. Hence it can be concluded that papaya Dengue virus induces bone marrow suppression leaf juice would definitely prove beneficial to resulting in low platelet count. Anaemia and spontaneous severe bleeding are the other consequences of bone marrow suppression. effectiveness and easy availability of papaya Dengue virus can bind to human platelets in presence of virus specific antibody and cause References:
immune mediated clearance of platelets.5 A study suggested that hemorrhage in dengue Peters CJ. Infections caused by arthropod and rodent without circulatory collapse is most likely due to borne viruses. In Harisson’s Principles of Internal activation of platelets rather than coagulopathy, Medicine. Fauci AS, Braunwald E, Kasper DL, which is well compensated. Vascular alteration Hauser SL, Longo DL, Jameson JL, et.al. 17thedition. may be the principal factor involved in the USA: The McGraw-Hill Companies, Inc; 2008. Wikipedia, the free encyclopedia. Dengue fever. The journey to drug discovery through the study http://en.wikipedia.org/wiki/Dengue_fever (accessed of immune-modulatory effects against dengue infection lies on the research of generic Hettige S. Salutary effects of Carica papaya leaf extract in dengue fever patients–a pilot study. Sri alkaloids have been proven effective against anti-platelet macrophages in patients suffering from Idiopathic Thrombocytopenic Purpura Selisko B, Dutartre H, Guillemot JC. Comparative (ITP).7 The saponins in Panaxnoto ginseng have mechanistic studies of de novo RNA synthesis by been shown to reduce platelet adhesion and aggregation, prevent thrombosis and improve microcirculation.5 Carica papaya leaves contain various phytoconstituents like saponins, tannins, Wang J, Xu J, Zhong J. Effect of Radix notoginseng cardiac glycosides and alkaloids. The alkaloids saponins on platelet activating molecule expression present include carpaine, pseudocarpaine and and aggregation in patient with blood hyperviscosity dehydrocarpaine I and II. These constituents can syndrome. Zhing guo Zhong XI Yi Jie He Za Zhi act on the bone marrow, prevent its destruction and enhance its ability to produce platelets. Moreover, it can also prevent platelet destruction in the blood and thereby increase the life of the Krishnamurti C, Kalayanarooj S, Cutting MA, Peat platelet in circulation.8 Carica papaya was found RA, Rothwell SW, Reid TJ, et.al. Mechanisms of to have protective effect on the bone marrow hemorrhage in dengue without circulatory collapse. and stimulate haemopoiesis of the cells, Am. J. Trop. Med. Hyg 2001; 65(6): 840–7. Ahn Y, Bymes J, Harrington W, Cayer M, Smith D, Brunskill D, Pall M. The treatment of idiopathic In the present case, it was observed that upon thrombocytopenia with Vinblastine-loaded platelets. N administration of papaya leaf juice, both the platelet and total white cell count were restored Patil S, Shetty S, Bhide R, Narayanan S. Evaluation of to normalcy as suggested by the above studies Platelet Augmentation Activity of Carica papaya Leaf and the patient was relieved of all subjective Aqueous Extract in Rats. Journal of Pharmacognosy Journal of Ayurveda and Holistic Medicine | July, 2013 | Vol 1 | Issue 3 Deepak BSR, Girish KJ, Jadhav LL: Effect of papaya leaf juice in dengue fever: a case report Tham CS, Chakravarthi S, Haleagrahara N, Alwis RD. Complementary and Alternative Medicine 2013; Morphological study of bone marrow to assess the effects of lead acetate onhaemopoiesis and aplasia and the ameliorating role of Carica papaya extract. Exp Cite this article as: Deepak BSR, Girish KJ, Jadhav LL. Effect of papaya leaf juice on platelet and WBC count in 10. Subenthiran S, Choon TC, Cheong KC, Thayan R, dengue fever: a case report. Journal of Ayurveda and Teck MB, Muniandy PK et.al. Carica papaya leaves juice significantly accelerates the rate of increase in platelet count among patients with dengue fever and Source of support: Nil, Conflict of interest: None Declared Journal of Ayurveda and Holistic Medicine | July, 2013 | Vol 1 | Issue 3

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