INDIAN MEDICAL GAZETTE – DECEMBER 2014

A Pilot Study to Evaluate the Effectiveness of Carica Papaya Leaf Extract in Increasing the Platelet Count in Cases of Dengue with Thrombocytopenia

• A. C. Gowda, Consulting Physician, Poornima Hospital, RT Nagar, Bangalore.
• N. Vijay Kumar, Medical Director and Consulting Physician, S V Hospital, Madiwala, Bangalore.
• P. N. Kasture, Sr. Medical Advisor, Medical Services, K. H. Nagabhushan, Vice President, Medical Services — Micro Labs Ltd., Bangalore.

Abstract

The subjects were randomized into two groups, as control and intervention group. Both the groups were managed by the standard management guidelines for dengue except steroid administration. In addition to this the intervention group received CPLE tablet three times daily for five days. All of them were followed daily with platelet monitoring. The results showed that CPLE had significant increase in the platelet count (p<0.003) over the therapy duration, in dengue fever patients, reiterating that it accelerates the increase in platelet count compared to the control group. There were few adverse events related to GI disturbance like nausea and vomiting which were similar in both groups. Thus this study concluded that Carica papaya leaf extract (CPLE) does significantly increase the platelet count in patients with thrombocytopenia associated fatal, the dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). The 1997 WHO classification divided dengue into undifferentiated fever, dengue fever (DF), and dengue haemorrhagic fever (DHF)1. Four main characteristic manifestations of dengue illness are (i) continuous high fever lasting 2-7 days; (ii) haemorrhagic tendency as shown by a positive tourniquet test, petechiae or epistaxis; (iii) thrombocytopoenia (platelet count<100x109/1); and (iv) evidence of plasma leakage manifested by haemoconcentration (an increase in haematocrit 20% above average for age, sex and population), pleural effusion and ascites, etc2.

An incubation period varying from 3 to 14 days is followed by a febrile illness consisting of sudden-onset fever, headache, myalgia, arthralgia and rash. Thrombocytopenia is a common feature of the illness6 . The patient develops hemorrhagic manifestations such as petechiae and bleeding through the nose, gastrointestinal tract and gums. After the incubation period, the illness begins abruptly and, in patients with moderate to severe disease, is followed by three phasesfebrile, critical and recovery (Fig. 1). Due to its dynamic nature, the severity of the disease will usually only be apparent around defervescence i.e during the transition of the febrile to the afebrile phase, which often coincides with the onset of the critical phase. (Note- Figure to be taken from the PDF)

IJM – INDONESIA

The effect of Carica papaya L. leaves extract capsules on platelets count and hematocrit level in dengue fever patient - Fenny YUNITA, Endang HANANI, Jusuf KRISTIANTO

Abstract

Indonesia is one of the countries with the highest cases of dengue fever in South East Asia. The number of patient and distribution are increases with increasing mobility and population density. Carica papaya L. (CP) belongs to Caricaceae family is a widely cultivated plant in Indonesia and has many health benefits. The leaves were believed to increase platelet count and dengue fever patient benefit, but there were very limited published reports on scientific evident. The objective of this study was to determine the effects of C. papaya leaves extract capsules (CPC) to dengue fever patient. The design of this study was randomized clinical trial with a sample size of 80 subjects. These subjects were randomized into two group of 40, including the control and intervention group (received two CPC three times daily). The results showed that CPC had significant increased the platelet count (p<0.05), maintained stability of hematocrit in the normal level, shorten hospitalization (p>0.05) in dengue fever patients, and accelerate the increased in platelet count compared with control group.

According to Ministry of Health and Family – India

https://www.nhp.gov.in/disease/musculo-skeletal-bone-joints-/dengue-fever

 Carica Papaya is used for Prevention and treatment of dengue and its symptoms

According to National Health Mission – Tamil Nadu

 (http://www.nrhmtn.gov.in/vbdc.html)

 The State which had reported 13204 cases in 2012 was able to reduce it to 6,122 cases in 2013. During the year 2014 (up to 15.05.2014) 590 Cases are reported with nil death. The Indian medicines such as Papaya juice extract, Nilavembu and Malaivembu kudineer along with conventional medicine are used for the control of Dengue. Daily surveillance is carried out and the disease is now under control.

According to Indian medical Association

(http://www.ima-india.org/ima/left-side-bar.php?scid=383)

• Fresh C. papaya leaf extract significantly increased the platelet and RBC counts in the test group vs controls. (Asian Pac J Trop Biomed. 2013 Sep; 3(9):720-4)
  o   Carica papaya leaf extract can mediate a Th1 type shift in human immune system. (J Ethnopharmacol. 2010 Feb; 127(3):760-7)
  o   Plant extracts of Quercus lusitanica have maximum activity against DENV-2 replication of Dengue virus. (Dengue Bull. 2006; 30:260–269)
  o   C. papaya contains two important biologically active compounds viz. chymopapain and papain. (Biochem Biophys Res Commun. 2006 Mar 10; 341(2):620-6)
  o   A recent in vitro study demonstrated the possible effectiveness of cocktail extracts prepared from four species of phyllanthus against the DENV. (BMC Complement Altern Med. 2013; 13:192)
  o   Carica papaya leaves juice significantly increases the platelet count in patients with dengue fever and dengue hemorrhagic fever. (Evid Based Complement Alternat Med. 2013; 2013:616737)
  o   Thrombocyte count had increased from 28000/micro liter to 138000/micro liter at the end of 5 days. (J Pak Med Assoc. 2014 Mar;64(3):364-6)
  o    Carica papaya leaves have anti-inflammatory activity.  (Inflammopharmacology. 2008 Aug;16(4):168-73)
  o   C. papaya leaf extract at a dose up to 14 times the levels employed in practical use in traditional medicine in Malaysia could be considered safe as a medicinal agent. (Molecules. 2012 Apr 10; 17(4):4326-42)