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Unconventional treatments in dengue fever


Unconventional treatments in dengue fever

 Dr K K Aggarwal, President Heart Care Foundation of India

  1. Simple dengue fever requires only observation and reduction of fever using paracetamol.
     
  2. Severe dengue is marked by capillary leakage, which manifests as a rise in hematocrit and rapid fall in platelet count. Failure to timely correct intravascular dehydration may be potentially life-threatening.
    Capillary leakage occurs due to endothelial dysfunction. Endothelium acts as the major barrier to fluid leakage. Therefore, treatment of dengue is to treat the endothelial dysfunction.
  3. Death in patients with dengue fever is due to dehydration and organ failure and not due to fall in platelet counts. The rising hematocrit can be treated by any fluid replacement. Fall in platelets is self-limiting and requires no replacement unless associated with active bleeding.
     
  4. Giving platelet transfusions or increasing platelets counts without taking care of dehydration will cause no good.
     
  5. There is no scientific study in modern medicine that says that goat milk heals endothelial dysfunction. If it helps, it may help only because of it being a fluid and not as goat milk. Raw goat milk can carry harmful bacteria such as salmonella, E. coli and Listeria and other germs that can cause foodborne illnesses and may make one very sick. Raw milk is milk that has not been pasteurized to kill harmful bacteria.  As per United States Centers for Disease Control and Prevention (CDC), between 1993 and 2006, more than 1500 people in the US became sick from drinking raw milk or eating cheese made from raw milk. Also, that unpasteurized milk is 150 times more likely to cause foodborne illness and results in 13 times more hospitalizations compared to illnesses involving pasteurized dairy products. Certain population groups such as people with weakened immune systems, older adults, pregnant women, children and teenagers are especially susceptible to the dangerous bacteria in raw milk.
     
  6. Brucellosis: Drinking raw goat milk can also cause brucellosis.  It presents with fever, night sweats, malaise, loss of appetite (anorexia), joint pain (arthralgia), fatigue, weight loss and depression. These symptoms may either develop suddenly or gradually over several days to weeks. The most common involved systems are the musculoskeletal and genitourinary systems. Neurobrucellosis, endocarditis and hepatic abscess occur in 1 to 2 percent of cases. Think of brucellosis, if a person presents with otherwise unexplained fever and nonspecific complaints and has a possible source of exposure (e.g., contact with animal tissues, ingestion of unpasteurized goat milk or cheese).  ELISA test confirms the diagnosis.
     
  7. Several studies published in literature (as found on Pubmed search and Medline) have examined the use of papaya leaves in the treatment of dengue fever.
    o   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)
    o   In vitro upregulated synthesis of IL -6 and SCF both in peripheral blood leukocytes and stem cells from human exfoliated deciduous teeth reveals the potential mechanism of unripe papaya to induce thrombopoietic cytokines synthesis in cells of hematopoietic and mesenchymal origin. (BMC Complement Altern Med. 2015 Jul 8;15:215)  
    o   Incubation with fermented papaya preparation may have a protective effect on platelets from patients with type 2 diabetes mellitus, by preventing the progression of oxidative damage associated with diabetes and its complications. (Nutr Metab Cardiovasc Dis. 2015 Feb;25(2):224-9)
    o   Thrombocyte counts in mice increased after the administration of papaya leaf suspension. (Wien Klin Wochenschr. 2009 Oct;121 Suppl 3:19-22)
    o   Fermented papaya preparation, as a potent antioxidant, might alleviate symptoms associated with oxidative stress in severe forms of thalassemia. (Phytother Res. 2008 Jun;22(6):820-8)
  8. These studies confirm some role of papaya leaves in dengue fever. Those systems of medicine who practice them should continue doing so as long as they also advise management of timely intravascular dehydration.
     
  9. Guduchi, also known as Giloy (Tinospora cordifolia) is a well-known Ayurvedic herb, which is used extensively in treatment for fever. There is plenty of published literature relating to guduchi.
    o   Guduchi Ghana has anti-inflammatory activity. (Ayu. 2014 Jan;35(1):108-10)
    o   Guduchi has analgesic activity (J Clin Diagn Res. 2014 Aug;8(8):HC01-4)
    o   The methanolic extract of T. cordifolia has considerable antimicrobial activity against S. mutans, E. faecalis and S. aureus. (Eur J Dent. 2014 Apr;8(2):172-7)
    o   The stem of guduchi contains alkaloidal constituents, including berberine and bitter principals, including columbin, chasmanthin, palmarin, tinosporon, tinosporic acid and tinosporol. The drug is reported to possess one fifth of the analgesic effect of sodium salicylate. (http://www.himalayawellness.com)
     
  10. Dengue nosode is homeopathic way of treating dengue and may be of use in serotype specific dengue.
  • All pathy experts must agree on adequate fluid replacement (oral or intravenous) in patients with dengue fever, timely identification of danger signals and transfer for ICU care where indicated.
    o   Formula 1: Simple dengue fever: 500 ml fluid at time of diagnosis and then 100 ml per hour; patient must pass urine every 4 hours
    o   Formula 2: Severe dengue fever: Drink 1.5 liter of fluid at diagnosis and then drink 150 ml per hour; patient must pass urine every 4 hours
  • Formula of 20: Physicians should remember the Dr KK’s Formula of 20 to identify high risk patients with dengue fever.  
    o   Rise in pulse by more than 20.  
    o   Fall in upper BP by more than 20.  
    o   Difference between lower and upper blood pressure of less than 20.  
    o   Rapid fall of platelet count to less than 20,000 and simultaneous rise in hematocrit by more than 20%
    o   Presence of more than 20 hemorrhagic spots on the arm in one inch after tourniquet test.

    Start fluid replacement immediately at the rate of 20 ml/kg body weight in 20 minutes (or till he/she passes urine) and then follow with 150 ml fluids per hour to let pass urine every 4-5 hours.
  • We must respect all pathies. They must practice their own systems.