POST TIME: 19 August, 2019 00:00 00 AM
Papaya leaves juice and platelet count in dengue
Treatment for dengue is usually symptomatic. Some cases require platelet transfusions and fluid management
Dina Farhana

Papaya leaves juice and platelet count in dengue

The number of dengue cases in this year exceeds all the past reports and has diffused in most of the districts of Bangladesh.  Allowing dengue a serious public health issues and the Government of Bangladesh and across sectors all are concentrating their effort to tackle it. With the recent outbreak, the name of papaya leaves juice is coming repeatedly in managing dengue. Especially the social media highlighting the use of papaya leave for dengue management and debates and discussion is going with this raising concern. Lack of referring the proper evidences in response to the growing concern we are not guiding with exact information. Therefore, this current review might rid confusion based on literature available.

This review highlights the Dengue features, available evidence related to the efficacy and safety of C. papaya leaf extract in dengue and to synthesize the evidence in meaningful form for its better implications. The review is based on literature available on Pubmed and Google in last decade using key words. A total of 8 studies reviewed which included one animal study, one case report, three case series, two randomized controlled trials and one systematic review and Meta analysis.  

Dengue is a viral infection caused by four closely related, but antigenically distinct serotypes of the Flaviviridae family, which are designated as dengue virus (DENV).  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. Following this, there is an apparent phase of improvement and in severe forms symptoms such as vomiting, pain in the abdomen, red spots, reduction in urine output, change in alertness, and bleeding can occur. The red flag sign, citing the severity in serious dengue is a fluid leak from blood vessels and capillaries from the nose, gums, skin, lung vessels, intra-abdominal areas, etc. known as hemorrhagic fever. Pathogenesis of bleeding involves leakage of plasma from the blood vessels. Deaths due to dengue are usually a consequence of patients developing complications like dengue hemorrhagic fever and dengue shock syndrome

Treatment for dengue is usually symptomatic. Some cases require platelet transfusions and fluid management. There are no effective antiviral agents available to treat dengue complications yet. A lot of hope rests on the development of effective vaccines, many of which are undergoing clinical trials. Besides vaccines, every other possible treatment including traditional medicines are being investigated to test their usefulness in controlling this problem. Studies based on animal and human are highlighting here.

A study in mice found an increase in thrombocyte counts administering 15 mg of powdered papaya leaves/kg body weight between 1 and 12 h following dosing and another study found that aqueous extract at concentrations of 400 mg/kg and 800 mg/kg significantly increased the platelet counts which also reduced the clotting time in the treated rats.

Treatment of dengue using C. papaya leaf extract in humans has been reported in very few studies conducted in Asia.

•    A pilot study was conducted in Sri Lanka on 12 patients suspected of suffering from dengue received 2 doses of papaya leaf extract at intervals of 8 h along with standard symptomatic care for dengue found an increase in platelet count and total white blood cell count in patients.

•    A case report from Pakistan described that a patient with Dengue received 25 mL of papaya leaf extract twice a day for 5 days which observed a steady increase in the platelet and white blood cell count.

•    A study conducted among 80 patients in Indonesia used C. papaya leaves extract capsules (CPC), randomized into two groups observed that platelets in patients with dengue in the intervention group increased faster in those who were administered the CPC which also fasten recovery and reduce hospitalization.

•    A report in the British Medical Journal website described the rapid recovery of platelet counts in two children suffering from dengue, in one case within 12 h of initiating treatment and in the second case, it increased within 2 days, hence the duration of treatment was not mentioned in the report.

•    A study in the journal of Medicinal and Aromatic Plants reported an increase in platelet counts in five patients within 24 h who had taken papaya leaf extract for dengue. However, no other detail information available on whether the dengue was confirmed,  other treatment given, whether platelet count is significant.

•    A study conducted in Malaysia had a more systematic approach in evaluating the use of papaya leaf juice in the treatment of dengue. Total 290 patients confirmed to be suffering from dengue were randomized and the patients in the intervention group were administered fresh juice from 50 g once a day 15 min after breakfast for 3 consecutive days along with the standard treatment for dengue which found that significant increase in the platelet counts. Same study observed an increase in arachidonate 12-lipoxygenase and the platelet-activating factor receptor gene expression in the intervention group. These genes are associated with increased platelet production.

•    Recently a systematic review and meta-analysis also designed to search the available evidence related to the efficacy and safety of C. papaya leaf extract in dengue. Total four trials enrolling 439 subjects were included, which was found to be associated with increase in platelet count in the overall analysis.  

All literature available summarizes that C. papaya leaves extract is significantly associated with the increase in platelet counts in the patients of dengue.

Problem in selecting the inclusion criteria, number of cases enrolled in study, amount of extract given, actual mechanism of beneficial effects, consideration of bias and geography are serious issues need attention raises all the reports reviewed.

The juices of papaya leaves used mostly obtained from trees that were grown without insecticides or pesticides. Many studies also excluded pregnant and lactating women and people in special need. Moreover, the number of cases included for the trails found very small and most of them have presumed that the patients suffer from dengue due to the presence of thrombocytopenia and have not confirmed the diagnosis. Moving to the platelet count-still the mechanism is not known. The reports highlights the association might be due to its membrane-stabilizing property. Also the flavonoids and other phenols present in extract might have beneficial effect. Papaya plants are rich in minerals may balance the mineral deficiency caused by the virus by strengthening the immune cells. Most of the cases given extract in different dosages, standardization of dose and form are also essential to make any consensus. It is also necessary to conduct pharmacokinetic studies to ensure that the active principle is absorbed from the digestive tract.

There is a statistically significant positive effect on the rise of platelet count, but whether this rise is clinically significant or not- underlined as the limitations of the studies. However, reports suggested need of evidence in the form of large clinical trials before a decision related to the use of such extract is made. The last review (systematic and meta analysis) not suggested the use of C. papaya leaves juice in dengue as data of safety was not properly measured and reported in the included clinical trials.

The writer is a nutritionist

Email: dinafarhana927@yahoo.com