Subhash Chandra Arya ( Sant Parmanand Hospital, Delhi, India. )
Nirmala Agarwal ( Sant Parmanand Hospital, Delhi, India. )
Madam, we compliment the team of investigators at the Sunset Poly Clinic in Karachi, Pakistan for their management of Dengue virus (DENV) associated thrombocytopenia in the 23 year-old male by the five day recipe of Circa papaya leaves extract.1 We agree further well controlled studies should be carried out to establish the beneficial effects of Circa papaya leaves extract in DENV patients presenting with primary and secondary infection.
There can be wide variation in platelet counts in cases with dengue virus infection as was evident during the 2010 outbreak of DENV infection in Delhi, in 1,886 cases that were tested concurrently for DENV NS1 antigen, IgM, IgG along with an enumeration of circulating platelets. Of the 1,886 patients screened with the \'Dengue Package\', 678 and 1208 were NS1-positive and -negative respectively, in different combinations. In 394 cases, NS1 was exclusively positive while 29 were also IgG positive. In 942 cases NS1, IgM and IgG were negative (triple negative), platelet counts in the NS1 positives were lower than the NS1 negatives, mean and standard deviation (SD) 116.8±70.2 x 109/L: 95% confidence interval (CI) 66.6-74.1 and 167.2±94.0 x 109/L, P<0.0001. Platelet counts were <20 x 109/L in 20 NS1 antigen-positives and 42 NS1 antigen-negatives.2
We feel that the Circa papaya leaves extract1 might emerge as the ideal and exclusive recipe towards management of the DENV associated thrombocytopenia in patients belonging to Jehovah\'s Witnesses (JW) community, reporting at the Narayana Hrudayalaya-Mazumdar Shaw Cancer Centre, Bangalore,3 or other groups who as a matter of religious belief would have refused transfusions of blood/blood components.
In conclusion, prospective investigations with circa papaya leaves extract1 in DENV-endemic regions could guarantee insignificant requirement of frequent platelet transfusions in patients with thrombocytopenia.
1. Siddique O, Sundus A, Ibrahim MF.Effects of papaya leaves on thrombocyte counts in dengue--a case report.J Pak Med Assoc 2014; 64: 364-6.
2. Arya SC, Agarwal N, Parikh SC, Agarwal S. Simultaneous detection of dengue NS1 antigen, IgM plus IgG and platelet enumeration during an outbreak. Sultan Qaboos Univer Med J 2011; 11: 470-6.
3. Prashantha B, Varun S, Sharat D, Murali Mohan BV, Ranganatha R, Shivaprasad, Naveen M. Prophylactic platelet transfusion in stable dengue Fever patients: is it really necessary?Indian J Hematol Blood Transfus 2014; 30: 126-9.