To the Editor, The acute infectious illness dengue is spread by mosquitoes and has a high death and morbidity rate affecting people of all ages and is spread by mosquito bites, most frequently by the Aedes aegypti and Aedes albopictus species1. In Asia, dengue is currently the top cause of hospitalization and fatalities among individuals, and about 70% of dengue illness cases worldwide are found in Asia2. Historically in Pakistan alone, dengue has been identified as a significant public health issue with several outbreaks reported in 2010, 2017, 2019, and 2020. In 2022, between January 1 and September 27, Pakistan has once again seen a resurgence of dengue with a total of 25,932 confirmed cases and 62 fatalities3. The treatment of dengue involves supportive care with increased fluid intake and antipyretics. However, with the increasing burden of dengue on hospitals in Pakistan, people have transitioned to seek other remedies such as papaya leaves, goat milk, guava, and neem tree leaves4. There has been a dramatic rise in demand for papaya leaf juice across Pakistan because of the recent dengue outbreak. The community quickly adopted the use of papaya in the treatment of dengue because of its perceived positive impact on the platelet count in the opinion articles, news stories, and blogs that have begun to appear in print, social media, and national media4. Despite the lack of specialized medication, papaya leaf extract (PLE) is a natural remedy for dengue. Patients who drink plant juice frequently report fewer symptoms of dengue fever and improved general health. The primary active compound in PLE that contributes to the anti-thrombocytopenic action and increases the patient’s blood platelet count is carpaine5. Numerous studies that have been published have found a connection between platelet count and the prognosis of dengue6. Furthermore, papaya leaf extract can boost the immune system and lower inflammation7. According to a meta-analysis, a viable option for raising the platelet count in dengue patients was Carica papaya leaf extract8. However, patient mortality, safety parameters, and side effects were not taken into consideration in this study which leaves doubts about implementing it into actual clinical practice. Even though these studies show that PLE has anti-thrombocytopenic capabilities, it is still unclear how effective PLE is at treating dengue symptoms. Results from another investigation showed that rats’ liver and reproductive systems were negatively impacted by papaya aqueous extract9. In another research, adult male rats’ sperm counts, sperm viability, and testosterone levels all significantly decreased. In addition, female rats also showed infertility issues along with an increase in maternal mortality10. Although the aforementioned trials used animals, it is still necessary to conduct descriptive studies to identify and assess the chemical components of the leaves, their concentrations, and their toxic side effects to properly utilize papaya plant parts and to commercialize the appropriate products for nutraceutical uses. Although papaya leaf has effective anti-thrombocytopenic properties, people using it may experience nausea and vomiting. Furthermore, the usage of papaya or its leaves does not benefit dengue patients in any way and can instead lead to diarrhea11. Given that dengue patients already require enough fluids, this might be fatal. Patients who lose excessive fluid risk developing hypovolemic shock. Multiorgan failure, disseminated intravascular coagulopathy, and gastrointestinal bleeding are also risks of protracted shock12. Considering the negative effects of PLE on patients suffering from dengue, it should be contraindicated to use papaya leaf to reduce death and morbidity. In conclusion, until descriptive research and clinical trials are carried out to ascertain its treatment effectiveness, the use of PLE for treating dengue symptoms in patients with dengue fever must be contraindicated. Insecticide-treated textiles, the use of mosquito repellent coils, the use of bed nets while in bed even during the day, and the development of the habit of wearing full-sleeve shirts and pants must all be encouraged. The general public must be informed and warned about the dangers and possible side effects of using papaya leaves during dengue fever. Ethical approval None. Sources funding None. Author contribution A.N. was involved in the study concept, the collection of the data, drafting, literature review, data validation, supervision, and editing of the manuscript. R.T. was responsible for the literature review and revising the manuscript for important intellectual content. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None. Clinical trial registration None. Data availability statement None. Patient consent statement None.
Read full abstract