Sunday April 13, 2014
BY TAN SHIOW CHIN
DENGUE fever is a problem that just does not seem to want to go away in Malaysia. And even worse, it seems to be escalating.
The latest report from the Health Ministry states that as of March 22, both the number of cases and deaths nationwide for the year have increased by 314% compared to the same period last year.
The number of dengue cases in the latest report totalled 23,633, while the number of deaths was 58.
The problem is not just limited to Malaysia, although we are considered an endemic dengue hotspot.
The World Health Organisation (WHO) estimates there may be 50-100 million dengue infections globally every year, with two-fifths of the world population, or 2.5 billion people, at risk of this mosquito-borne infectious disease.
While being infected with dengue is an unpleasant experience – it is also known as breakbone fever – with typical symptoms being fever, headache, rashes, and muscle and joint pains, a healthy person’s immune system usually has no problems fighting the virus off.
The problem comes when dengue haemorrhagic fever develops.
This extreme form of the illness causes severe bleeding due to “leaky” blood vessels and delay in blood-clotting caused by low levels of platelets, which are essential in forming blood clots.
According to the WHO, an average of about 2.5% of those who develop dengue haemorrhagic fever die.
This number can exceed 20% in cases with no proper treatment, while the risk of death in those who receive the proper supportive treatment is less than 1%.
There is no cure for dengue, nor is there any vaccine for it, although there are several research teams currently working on one.
The main method of controlling this disease is via prevention; for example, ensuring that there is no stagnant water or any container where water can pool in around, fogging, using mosquito nets and repellent, and covering up or staying indoors at dawn and dusk when the Aedes mosquitoes are most active.
Medical management of dengue is purely supportive, with maintenance of the body’s fluid balance being the key objective, whether via oral rehydration therapy, intravenous fluid replacement, or in the worst-case scenario, blood transfusion.
With no definitive treatment from modern medicine available, it is not surprising that many have turned to alternative therapies for relief.
Papaya leaf juice
This is probably the most well-known alternative treatment for dengue.
Several small scientific studies have been carried out in dengue-endemic countries like India and Malaysia, looking into the efficacy of this herbal remedy.
While the results cannot be said to be definitive, due to their small study size, they are certainly promising.
The main effect of this juice lies in raising the level of platelets in dengue patients – a critical aspect of this viral infection.
One study, conducted by the Institute for Medical Research and Hospital Tengku Ampuan Rahimah, Klang, Selangor, reported that patients given papaya leaf juice showed a significant rise in their platelet levels 40 hours after first receiving the juice, compared to patients in the control group who were only on standard supportive therapy.
The open-label randomised controlled trial, published in Evidence-Based Complementary and Alternative Medicine last year, had a total of 228 participants recruited from the hospital’s dengue ward, divided almost equally between the control group and the juice group.
The patients in the juice group took the pure fresh juice extracted from 50gm of clean papaya leaves of the sekaki variety once daily for three consecutive days.
Pharmacist and holistic medicine practitioner Datuk Dr Rajen M adds that a blend of raw young papaya and papaya leaves made into a juice, taken two to three times a day, is one of the alternative therapies for dengue in Ayurvedic medicine.
He notes that consuming papaya in general is safe, and taking it does not contradict medical advice.
Tawa-tawa
This hairy herb is commonly used in the Philippines as an alternative treatment for dengue fever.
Also known as gatas-gatas or by its scientific name Euphorbia hirta, it is said to increase the platelet levels in dengue patients.
A 2012 animal study conducted by pharmacy students from the University of Santo Tomas, Manila, showed that a decoction of tawa-tawa did indeed increase platelet levels and decrease bleeding time in rats with induced thrombocytopenia (i.e. an abnormally low platelet level).
The Philippine’s Department of Science and Technology is currently researching the effect of this plant on dengue fever, and have stated their concern over possible toxicity resulting from overdosing on tawa-tawa.
Meanwhile, Philippine Star columnist Dr Willie T Ong said in a 2009 article that Filipino doctors in general allow dengue patients to take tawa-tawa as long as they clear it with them first.
He also explained how to prepare the herb: “Take five whole tawa-tawa plants. Cut off the roots, then wash and clean.
“Boil tawa-tawa in a pot of clean water. Pour the liquid and then let cool. Sip one glass three to four times a day.”
Traditional Chinese medicine
Inti International University Center for Traditional Chinese Medicine director and head of the traditional Chinese medicine (TCM) programme Dr Yong Kian Fui says that there is no cure for dengue fever in TCM either, and treatment is usually supportive based on the stage of the disease.
The acupuncturist and Chinese physician notes that because of the vague symptoms of dengue fever, most people are only diagnosed with the disease about four days after their fever starts.
TCM therapy at that stage consists of a herbal concoction based on the formulation called qin wen bai tu san.
“This helps to clear the plaque and detox the body,” he says.
Patients have to take one dose daily for three days. If their platelet levels are still low by the end of that period, Dr Yong says they would be referred to the hospital for further management.
He adds that he personally also prescribes a bitter gourd and meat soup, which should be double-boiled for two hours.
While the meat can be from any animal, including fish, it is crucial that the seeds in the bitter gourd must be included in the soup.
“According to TCM theory, bitter gourd is used to clear ‘fire’ and to detox the body.
“The meat neutralises the bitter gourd, so that it doesn’t become too ‘cooling’.”
Ayuverdic medicine
Dr Rajen explains that there are four ways to treat dengue patients according to Ayuverdic medicine.
Two methods are targeted at boosting the patient’s blood production and providing an antiviral effect: the papaya fruit and leaf juice mix mentioned earlier, and juice made from pegaga leaves, also known as India pennywort or Centella asiatica.
According to Dr Rajen, one dose of the pegaga juice is the amount obtained from juicing one handful of leaves.
The other two treatments are mainly applied for their general antiviral properties.
One is cow or goat colostrum, which can be drunk as often as desired. Colostrum is the first secretion from the animal’s mammary glands before the milk comes out.
The other is turmeric, which can be added to the patient’s food or milk.
