1. Introduction
Dengue viruses, mosquito-borne members of the
Flaviviridae family, are the causative agents of dengue
fever[1]. Dengue is the most important emerging viral
disease of humans that in recent decades has become
a major international public health concern. Dengue is
found in tropical and sub-tropical regions around the
world, predominantly in urban and semi-urban area[2].
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
hospitalization[3]. Dengue fever is spread through the
bite of an infected Aedes aegypti mosquito. The mosquito
gets the virus by biting an infected person[4]. The first
symptom of the disease appears in about 5-7 days after
the infected mosquito bites a healthy person. It is possible
to become infected by dengue multiple times because
the virus has four different serotypes. Although each
infection confers lifelong immunity to that particular
serotype, a subsequent infection with a different serotype
increases the risk of contracting the much deadlier
form known as dengue hemorrhagic fever (DHF)[5]. The
symptoms of dengue fever include high fever, rash, and
a severe headache (dengue triad). Additional symptoms
include severe joint and muscular pain (breakbone fever),
nausea, vomiting, and eye pain. Although dengue fever
itself is rarely fatal, it can be an extraordinarily painful
and disabling illness and may become epidemic in a
population following the introduction of a new serotype.
Dengue fever is usually a self-limited illness, and only
supportive care is required. Acetaminophen may be used
to treat patients with symptomatic fever. Aspirin, Brufen
nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics
and corticosteroids should be avoided as these do not help
but cause gastritis and/or bleeding. In children, Reye’s
syndrome (encephalopathy) may be a serious complication.
Patients with known or suspected dengue fever should have
their platelet count and Hematocrit measured daily from
the third day of illness until 1-2 days after defervescence.
No vaccine is available for the prevention of dengue
infection. Immunogenic, safe tetravalent vaccines have
been developed and are undergoing clinical trials. The only
way to prevent dengue virus acquisition is to avoid being
bitten by a vector mosquito[1-4]. Fresh plant materials of
Carica papaya (C. papaya) were collected from University of
Peshawar. Their botanical identities were determined and
authenticated by Dr. Lajber Khan, Head, Medicinal Botanic
Centre (MBC), PCSIR Laboratories Complex, Peshawar KPK,
Pakistan. The plant material was washed with water, cut into
pieces and grinded with blender. 25 mL of aqueous extract of
C. papaya leaves was administered to patient infected with
Dengue fever. The same doze was given to the patient twice
daily i.e. morning and evening for five consecutive days. By
72 hours, effectiveness of the water extract was investigated
biochemically from blood samples. Serum was separated
by centrifugation at 3 000 rpm for 15 minutes. The separated
serum profile was used for the estimation of biochemical
parameters like Platelets count (PLT), White Blood Cells
(WBC), Red Blood Cells (RBC) and Neutrophils (NEUT), etc.
2. Case report
A male patient aged 45 years old working as truck driver in
a cement factory, was brought to the emergency department
with sever fever of 104 曘F. The symptom included breathing
problem, sever vomiting, red skin, shivering, sever body
pain and high blood pressure. He reported that he had been
driving truck and transporting cement to various regions
of KPK, Pakistan. During his journey he used to stay at
different locations for food, at that time he was bitten by
mosquito carrying Dengue virus. After 24 hr of which he
started feeling sever pain in whole body with fever and
teary eyes. These symptoms increased time to time over the
passing hours, which were followed by vomiting. In the same
days three to four patients surrounding the mentioned area
(Figure 1) died of Dengue fever. Subsequently the patient was
admitted in emergency unit in Abottabad Medical Complex.
On the basis of screening blood test examination he was
declared to be a victim of Dengue fever.
The serological studies revealed an abrupt decline in the
patient platelets counts. The patient has been given different
broad spectrum antibiotics and anti malarial drugs but there
were no signs of improvement, and his condition became
worse time by time. He had been given different food items
but unfortunately vomiting did not stopped. At the same
time our team was working on the biological activities of
C. papaya. For the patient’s treatment, the leaves of the
plant (Figure 2) were collected and thoroughly washed with
water. The leaves were grinded in fruit juicer with water. As
the taste of C. papaya leaves extract was very bitter, some
amount of sucrose was added for easy administration. About
25 mL of leaves extract was administrated orally, twice daily
for five consecutive days. Before extract administration,
the patient blood was evaluated for total platelets counts,
after 24 hours each time. After extract administration the
patient blood was rechecked for platelets counts again
for five consecutive days. After which the patient starts
improvement.
Before administration of leaves extracts, the patient
blood test have been taken. In patient target area there was
no specific lab to identify Dengue virus in patient blood.
Therefore.from the tests results it was observed that PLT,
WBC and NEUT decreased from normal level. After the
infection the patient immediately felt fatigue and fever,
these symptoms aggravated over the night. In the same
month of October 2010, most patients of Dengue fever died, so from
the patient symptoms and blood reports physicians recommended
hospitalization. From the first blood report it was observed that
PLT count was176暳103/毺L,WBC 8.1暳10
3
/毺L and NEUT 84.0%,
respectively. In the second report PLT count was 122暳
10
3
/毺L, WBC 6.6暳10
3
/毺L and NEUT 81.5%. The third day
report showed the PLT counts, WBC and NEUT were 110暳
10
3
/毺L, 4.4暳10
3
/毺L and 71.8%, respectively. PLT, WBC and
NEUT decreased very fast. The physicians told the family
members of patient that if the PLT count were below 20暳10
3
/
毺L then he would begin bleeding and may die. Physicians
in different hospital recommend PLTs injection isolated
from donor blood. But in this case on the fourth and fifth
day the PLT count decreased to 71暳10
3
/毺L and 55暳10
3
/毺L,
respectively, while the WBC and NEUT reached to 4.0暳10
3
/毺L,
3.7暳10
3
/毺L and 60.0%, 46.0% respectively (Table 1). Different
antibiotics and anti-malarial drugs were administrated orally
and intravenously, but no successful results.
The C. papaya leaves extract in water was given to the
patient twice daily. The patient started vomiting as eating,
so physicians recommended fruits and fruit juices. 25 mL of
extract was given to the patient in the morning and evening.
After two consecutive days the blood samples were checked
for different parameters. In the first blood report it was
observed that the PLT count, WBC and NEUT increased to 73
暳10
3
/毺L, 3.8暳10
3
/毺L and 56.0%, respectively. With similar
dose of extracts, on the next day the blood report indicated
that the PLT count reach to120暳10
3
/毺L while WBC and NEUT
reach to 4.4暳10
3
/毺L and 64.2%, respectively. On the third day,
it was observed that PLT count (137暳10
3
/毺L), WBC (5.3暳10
3
/毺
L) and NEUT (71.1%) increased. In the fourth blood report (PLT:
159暳10
3
/毺L, WBC: 5.9暳10
3
/毺L and NEUT: 73.0%) and fifth
report (PLT: 168暳10
3
/毺L, WBC: 7.7暳10
3
/毺L and NEUT: 78.3%)
the PLT, WBC and NEUT reach to their normal levels (Table 2).
Figure 2. Different age leaves of C. papaya used for aqueous
extraction.
3. Discussion
The main objective of the current study is to investigate
the potential of C. papaya leaves extracts against Dengue
fever. The secondary metabolite of plants origin makes
up a vast repository of compounds with a wide range of
biological activities. There have been many reports of
higher plant extracts possessing relatively good potential to
inhibit viruses (Van Den Berghe, 1978). Many plants extracts
including Spilanthes calva, Sterculia guttata, Balanites
aegyptiaca, Vitex negundo, Solanum xanthocarpum,
Artemisia annua, Fagonia indica, Nerium indicum,
Trigonella foenum, in different solvents have been reported
to exhibit activity against Aedes aegypti L., a vector of
dengue fever[6-12].
The C. papaya leaves extract in water was given to the
patient twice daily. The patient started vomiting as eating,
so physicians recommended fruits and fruit juices. 25 mL of
extract was given to the patient in the morning and evening.
After two consecutive days the blood samples were checked
for different parameters. In the first blood report it was
observed that the PLT count, WBC and NEUT increased to 73
暳10
3
/毺L, 3.8暳10
3
/毺L and 56.0%, respectively. With similar
dose of extracts, on the next day the blood report indicated
that the PLT count reach to120暳10
3
/毺L while WBC and NEUT
reach to 4.4暳10
3
/毺L and 64.2%, respectively. On the third day,
it was observed that PLT count (137暳10
3
/毺L), WBC (5.3暳10
3
/毺
L) and NEUT (71.1%) increased. In the fourth blood report (PLT:
159暳10
3
/毺L, WBC: 5.9暳10
3
/毺L and NEUT: 73.0%) and fifth
report (PLT: 168暳10
3
/毺L, WBC: 7.7暳10
3
/毺L and NEUT: 78.3%)
the PLT, WBC and NEUT reach to their normal levels (Table 2).
Figure 2. Different age leaves of C. papaya used for aqueous
extraction.
3. Discussion
The main objective of the current study is to investigate
the potential of C. papaya leaves extracts against Dengue
fever. The secondary metabolite of plants origin makes
up a vast repository of compounds with a wide range of
biological activities. There have been many reports of
higher plant extracts possessing relatively good potential to
inhibit viruses (Van Den Berghe, 1978). Many plants extracts
including Spilanthes calva, Sterculia guttata, Balanites
aegyptiaca, Vitex negundo, Solanum xanthocarpum,
Artemisia annua, Fagonia indica, Nerium indicum,
Trigonella foenum, in different solvents have been reported
to exhibit activity against Aedes aegypti L., a vector of
dengue fever[6-12].
Dengue viruses, mosquito-borne members of the
Flaviviridae family, are the causative agents of dengue
fever[1]. Dengue is the most important emerging viral
disease of humans that in recent decades has become
a major international public health concern. Dengue is
found in tropical and sub-tropical regions around the
world, predominantly in urban and semi-urban area[2].
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
hospitalization[3]. Dengue fever is spread through the
bite of an infected Aedes aegypti mosquito. The mosquito
gets the virus by biting an infected person[4]. The first
symptom of the disease appears in about 5-7 days after
the infected mosquito bites a healthy person. It is possible
to become infected by dengue multiple times because
the virus has four different serotypes. Although each
infection confers lifelong immunity to that particular
serotype, a subsequent infection with a different serotype
increases the risk of contracting the much deadlier
form known as dengue hemorrhagic fever (DHF)[5]. The
symptoms of dengue fever include high fever, rash, and
a severe headache (dengue triad). Additional symptoms
include severe joint and muscular pain (breakbone fever),
nausea, vomiting, and eye pain. Although dengue fever
itself is rarely fatal, it can be an extraordinarily painful
and disabling illness and may become epidemic in a
population following the introduction of a new serotype.
Dengue fever is usually a self-limited illness, and only
supportive care is required. Acetaminophen may be used
to treat patients with symptomatic fever. Aspirin, Brufen
nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics
and corticosteroids should be avoided as these do not help
but cause gastritis and/or bleeding. In children, Reye’s
syndrome (encephalopathy) may be a serious complication.
Patients with known or suspected dengue fever should have
their platelet count and Hematocrit measured daily from
the third day of illness until 1-2 days after defervescence.
No vaccine is available for the prevention of dengue
infection. Immunogenic, safe tetravalent vaccines have
been developed and are undergoing clinical trials. The only
way to prevent dengue virus acquisition is to avoid being
bitten by a vector mosquito[1-4]. Fresh plant materials of
Carica papaya (C. papaya) were collected from University of
Peshawar. Their botanical identities were determined and
authenticated by Dr. Lajber Khan, Head, Medicinal Botanic
Centre (MBC), PCSIR Laboratories Complex, Peshawar KPK,
Pakistan. The plant material was washed with water, cut into
pieces and grinded with blender. 25 mL of aqueous extract of
C. papaya leaves was administered to patient infected with
Dengue fever. The same doze was given to the patient twice
daily i.e. morning and evening for five consecutive days. By
72 hours, effectiveness of the water extract was investigated
biochemically from blood samples. Serum was separated
by centrifugation at 3 000 rpm for 15 minutes. The separated
serum profile was used for the estimation of biochemical
parameters like Platelets count (PLT), White Blood Cells
(WBC), Red Blood Cells (RBC) and Neutrophils (NEUT), etc.
2. Case report
A male patient aged 45 years old working as truck driver in
a cement factory, was brought to the emergency department
with sever fever of 104 曘F. The symptom included breathing
problem, sever vomiting, red skin, shivering, sever body
pain and high blood pressure. He reported that he had been
driving truck and transporting cement to various regions
of KPK, Pakistan. During his journey he used to stay at
different locations for food, at that time he was bitten by
mosquito carrying Dengue virus. After 24 hr of which he
started feeling sever pain in whole body with fever and
teary eyes. These symptoms increased time to time over the
passing hours, which were followed by vomiting. In the same
days three to four patients surrounding the mentioned area
(Figure 1) died of Dengue fever. Subsequently the patient was
admitted in emergency unit in Abottabad Medical Complex.
On the basis of screening blood test examination he was
declared to be a victim of Dengue fever.
The serological studies revealed an abrupt decline in the
patient platelets counts. The patient has been given different
broad spectrum antibiotics and anti malarial drugs but there
were no signs of improvement, and his condition became
worse time by time. He had been given different food items
but unfortunately vomiting did not stopped. At the same
time our team was working on the biological activities of
C. papaya. For the patient’s treatment, the leaves of the
plant (Figure 2) were collected and thoroughly washed with
water. The leaves were grinded in fruit juicer with water. As
the taste of C. papaya leaves extract was very bitter, some
amount of sucrose was added for easy administration. About
25 mL of leaves extract was administrated orally, twice daily
for five consecutive days. Before extract administration,
the patient blood was evaluated for total platelets counts,
after 24 hours each time. After extract administration the
patient blood was rechecked for platelets counts again
for five consecutive days. After which the patient starts
improvement.
Before administration of leaves extracts, the patient
blood test have been taken. In patient target area there was
no specific lab to identify Dengue virus in patient blood.
Therefore.from the tests results it was observed that PLT,
WBC and NEUT decreased from normal level. After the
infection the patient immediately felt fatigue and fever,
these symptoms aggravated over the night. In the same
month of October 2010, most patients of Dengue fever died, so from
the patient symptoms and blood reports physicians recommended
hospitalization. From the first blood report it was observed that
PLT count was176暳103/毺L,WBC 8.1暳10
3
/毺L and NEUT 84.0%,
respectively. In the second report PLT count was 122暳
10
3
/毺L, WBC 6.6暳10
3
/毺L and NEUT 81.5%. The third day
report showed the PLT counts, WBC and NEUT were 110暳
10
3
/毺L, 4.4暳10
3
/毺L and 71.8%, respectively. PLT, WBC and
NEUT decreased very fast. The physicians told the family
members of patient that if the PLT count were below 20暳10
3
/
毺L then he would begin bleeding and may die. Physicians
in different hospital recommend PLTs injection isolated
from donor blood. But in this case on the fourth and fifth
day the PLT count decreased to 71暳10
3
/毺L and 55暳10
3
/毺L,
respectively, while the WBC and NEUT reached to 4.0暳10
3
/毺L,
3.7暳10
3
/毺L and 60.0%, 46.0% respectively (Table 1). Different
antibiotics and anti-malarial drugs were administrated orally
and intravenously, but no successful results.
The C. papaya leaves extract in water was given to the
patient twice daily. The patient started vomiting as eating,
so physicians recommended fruits and fruit juices. 25 mL of
extract was given to the patient in the morning and evening.
After two consecutive days the blood samples were checked
for different parameters. In the first blood report it was
observed that the PLT count, WBC and NEUT increased to 73
暳10
3
/毺L, 3.8暳10
3
/毺L and 56.0%, respectively. With similar
dose of extracts, on the next day the blood report indicated
that the PLT count reach to120暳10
3
/毺L while WBC and NEUT
reach to 4.4暳10
3
/毺L and 64.2%, respectively. On the third day,
it was observed that PLT count (137暳10
3
/毺L), WBC (5.3暳10
3
/毺
L) and NEUT (71.1%) increased. In the fourth blood report (PLT:
159暳10
3
/毺L, WBC: 5.9暳10
3
/毺L and NEUT: 73.0%) and fifth
report (PLT: 168暳10
3
/毺L, WBC: 7.7暳10
3
/毺L and NEUT: 78.3%)
the PLT, WBC and NEUT reach to their normal levels (Table 2).
Figure 2. Different age leaves of C. papaya used for aqueous
extraction.
3. Discussion
The main objective of the current study is to investigate
the potential of C. papaya leaves extracts against Dengue
fever. The secondary metabolite of plants origin makes
up a vast repository of compounds with a wide range of
biological activities. There have been many reports of
higher plant extracts possessing relatively good potential to
inhibit viruses (Van Den Berghe, 1978). Many plants extracts
including Spilanthes calva, Sterculia guttata, Balanites
aegyptiaca, Vitex negundo, Solanum xanthocarpum,
Artemisia annua, Fagonia indica, Nerium indicum,
Trigonella foenum, in different solvents have been reported
to exhibit activity against Aedes aegypti L., a vector of
dengue fever[6-12].
The C. papaya leaves extract in water was given to the
patient twice daily. The patient started vomiting as eating,
so physicians recommended fruits and fruit juices. 25 mL of
extract was given to the patient in the morning and evening.
After two consecutive days the blood samples were checked
for different parameters. In the first blood report it was
observed that the PLT count, WBC and NEUT increased to 73
暳10
3
/毺L, 3.8暳10
3
/毺L and 56.0%, respectively. With similar
dose of extracts, on the next day the blood report indicated
that the PLT count reach to120暳10
3
/毺L while WBC and NEUT
reach to 4.4暳10
3
/毺L and 64.2%, respectively. On the third day,
it was observed that PLT count (137暳10
3
/毺L), WBC (5.3暳10
3
/毺
L) and NEUT (71.1%) increased. In the fourth blood report (PLT:
159暳10
3
/毺L, WBC: 5.9暳10
3
/毺L and NEUT: 73.0%) and fifth
report (PLT: 168暳10
3
/毺L, WBC: 7.7暳10
3
/毺L and NEUT: 78.3%)
the PLT, WBC and NEUT reach to their normal levels (Table 2).
Figure 2. Different age leaves of C. papaya used for aqueous
extraction.
3. Discussion
The main objective of the current study is to investigate
the potential of C. papaya leaves extracts against Dengue
fever. The secondary metabolite of plants origin makes
up a vast repository of compounds with a wide range of
biological activities. There have been many reports of
higher plant extracts possessing relatively good potential to
inhibit viruses (Van Den Berghe, 1978). Many plants extracts
including Spilanthes calva, Sterculia guttata, Balanites
aegyptiaca, Vitex negundo, Solanum xanthocarpum,
Artemisia annua, Fagonia indica, Nerium indicum,
Trigonella foenum, in different solvents have been reported
to exhibit activity against Aedes aegypti L., a vector of
dengue fever[6-12].
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