Effects of Momordica charantia (MC) Extract on Clinical Symptoms, Parasite Account, Thrombocytes, Total Bilirubin and Direct Bilirubin in Patients with Uncomplicated Plasmodium falciparum Malaria: A Case Report

Clinical symptoms during the treatment of uncomplicated P. falciparum malaria have been reported in several studies. Parasite density in the blood is associated with clinical symptoms, platelet, and bilirubin count. A 52-year-old male, weighing 52 kg, was given one capsule containing 325 mg bitter melon (Momordica charantia) extract for 3 days of treatment. Patients were followed up for 28 days, days 1,2,3,4,7,14,21,28, and peripheral blood microscopic examination and clinical symptoms were carried out. Measurement of platelets, total bilirubin, direct bilirubin D0, D14 and D28. Naranjo Scale, adverse events measurements were taken on D7, no signs of severe malaria, no comorbidities, no history of malaria, blood pressure 110/80 mmHg, peripheral blood parasite examination on D0 found P. falciparum parasites of 31,714/µL, D0 platelet value of 94x10 /mm3, D0 total bilirubin value of 1.3 mg% and D0 direct bilirubin value of 0.6 mµ/mL. On D1 parasite count was 2,400/µL, D2 was 372/µL, D3, D4, D7, D14, D21, D28 no asexual parasites were found again. Clinical symptoms that arose on D0 were nausea, no appetite, sweating, chills, sleep disturbance, dizziness, headache, and weakness with a body temperature of 37°C. After D3 of bitter melon extract treatment, no clinical symptoms were found again. Naranjo scale score based on nurse and pharmacist agreement was 6 (probable) at D7 for the adverse events of nausea and vomiting. There were no reported adverse events such as nausea, vomiting, diarrhea, abdominal pain, cough, sleep disturbance, dizziness, headache and weakness on D2 treatment. Bitter melon extract is effective for uncomplicated malaria P. falciparum, reduces clinical symptoms, and is safe.


Introduction
Malaria is a deadly disease caused by plasmodium parasites.One of the plasmodium species that causes malaria is Plasmodium falciparum.Early diagnosis and appropriate treatment is one of the effective weapons used in the fight against this disease.Artemisinin, quinine, mefloquine, lumefantrine, amodiaquine, sulfadoxine, piperaquine, primakuine are currently used in the treatment of malaria. 1 A looming part of the failure to control malaria is the spread of antimalarial drug resistance.Although there have been no reports related to resistance to artemisinin derivatives in Indonesia, reports of resistance cases in Myanmar and the tendency of malaria parasites in the Southeast Asian region to develop resistance to antimalarials need to be well anticipated, one of which https://doi.org/10.37275/amcr.v5i1.417

A B S T R A C T
Clinical symptoms during the treatment of uncomplicated P. falciparum malaria have been reported in several studies.Parasite density in the blood is associated with clinical symptoms, platelet, and bilirubin count.A 52year-old male, weighing 52 kg, was given one capsule containing 325 mg bitter melon (Momordica charantia) extract for 3 days of treatment.Patients were followed up for 28 days, days 1,2,3,4,7,14,21,28, and peripheral blood microscopic examination and clinical symptoms were carried out.Measurement of platelets, total bilirubin, direct bilirubin D0, D14 and D28.Naranjo Scale, adverse events measurements were taken on D7, no signs of severe malaria, no comorbidities, no history of malaria, blood pressure 110/80 mmHg, peripheral blood parasite examination on D0 found P. falciparum parasites of 31,714/µL, D0 platelet value of 94x10 /mm 3 , D0 total bilirubin value of 1.3 mg% and D0 direct bilirubin value of 0.6 mµ/mL.On D1 parasite count was 2,400/µL, D2 was 372/µL, D3, D4, D7, D14, D21, D28 no asexual parasites were found again.Clinical symptoms that arose on D0 were nausea, no appetite, sweating, chills, sleep disturbance, dizziness, headache, and weakness with a body temperature of 37°C.After D3 of bitter melon extract treatment, no clinical symptoms were found again.Naranjo scale score based on nurse and pharmacist agreement was 6 (probable) at D7 for the adverse events of nausea and vomiting.There were no reported adverse events such as nausea, vomiting, diarrhea, abdominal pain, cough, sleep disturbance, dizziness, headache and weakness on D2 treatment.Bitter melon extract is effective for uncomplicated malaria P. falciparum, reduces clinical symptoms, and is safe.

Case Presentation
This report is about a 52-year-old male weighing 52 kg, based on a doctor's diagnosis and microscopic examination he was suffering from P. falciparum malaria.He was previously given an explanation and information on a leaflet before the action and   Total bilirubin (mg%) The results of the examination of adverse events of bitter melon (Momordica charantia) extract treatment with the Naranjo scale with patients by nurses and pharmacists during the D7 follow-up were agreed to a score of 6 (probable) for the adverse events of nausea and vomiting in Table 3.
Table 3. Results of adverse event screening using the Naranjo scale (vomit and nausea).

Discussion
This report looks at the effect of clinical symptoms before and after treatment for uncomplicated P. falciparum malaria.At H0, there were 9 (nine) clinical symptoms reported by patients.
Clinical symptoms that arise in patients are related to the density of P. falciparum parasites in the blood. 7Parasite density, endemicity level, antimalarial concentration in the blood, patient immunity, the presence of other severe diseases, pharmacodynamic profile of drugs affect the success of malaria parasite elimination which affects the clinical symptoms that arise. 3,6In uncomplicated P. falciparum malaria patients without symptoms, parasite density is not always related to the clinical symptoms that arise, but many research reports reveal that in non-immune patients as the number of parasites increases, the length of time and clinical symptoms that arise is getting longer. 11rasite density is associated with the development of complications and disease severity. 11,12Mangal et al's research shows that there is a relationship between parasite density and platelet values.In patients with falciparum malaria as the parasite density increases, the platelet value of P. falciparum malaria patients decreases. 7is report shows that bitter melon fruit extract (Momordica bilirubin and direct bilirubin values. 13Patients with high parasitemia tend to have high bilirubin values. 14Syamsudin et al research in vivo showed that bitter melon fruit extract (Momordica charantia) 320 mg/Kg/bb had no effect on AST/SGOT and ALT/SGPT values.Table 2 above shows that bitter melon fruit extract (Momordica charantia) improves the value of total bilirubin and direct bilirubin.The content of bioactive compounds from Momordica charantia as anti-inflammatory, anti-oxidant and immunomodulator is likely to improve the total bilirubin and direct bilirubin values of patients. 15,16The possibility of Momordica charantia extract has an antimalarial effect through modulation of cytokine mediation. 16The content of Momordica charantia extract in the form of alkaloids, flavonoids, terpenoids as antimalarial by forming chelates of parasite nucleic acid bases. 17e decrease in parasite density may be related to the measurement of blood chemistry values (total bilirubin and direct bilirubin). 11,12e efficacy of safe and convenient-to-use therapies is associated with the effectiveness of malaria therapy.The Naranjo scale method is used for the estimation of drug reaction adverse events. 10Syamsudin et al research on uncomplicated Plasmodium falsciparum patients in Manokwari, West Papua, reported weakness, headache, dizziness, sleep disturbance, chills, sweating, no appetite, nausea, vomiting, abdominal pain, diarrhea, muscle pain and cough. 6It is likely that these clinical symptoms are clinical manifestations of uncomplicated falciparum malaria. 7,12The use of bitter melon (Momordica

Interpretation of scores Total Score ≥9
Definite.The reaction (1) followed a reasonable temporal sequence after a drug or in which a toxic drug level had been established in body fluids or tissues, (2) followed a recognized response to the suspected drug, and (3) was confirmed by improvement on withdrawing the drug and reappeared on reexposure.Total Score 5 to 8 Probable.The reaction (1) followed a reasonable temporal sequence after a drug, (2)  followed a recognized response to the suspected drug, (3) was confirmed by withdrawal but not by exposure to the drug, and (4) could not be reasonably explained by the known characteristics of the patient's clinical state.Total Score 1 to 4 Possible.The reaction (1) followed a temporal sequence after a drug, (2) possibly followed a recognized pattern to the suspected drug, and (3) could be explained by characteristics of the patient's disease.Total Score ≤0 Doubtful.The reaction was likely related to factors other than a drug.

Conclusion
This case report is very special because this treatment of uncomplicated P. falciparum malaria patients with bitter melon fruit extract (Momordica charantia) has never been done before.
Bitter melon extract can be used as an alternative treatment for uncomplicated P. falciparum malaria in combination or alone.The results of the measurement of adverse events that occur need the addition of anti-nausea and vomiting drugs to avoid this so that the expected efficacy is more optimal.The measurement of adverse events with the Naranjo scale has limited resources that only involve nurses and pharmacists in determining adverse events that occur.Further research is needed with a larger number of patients, specialized laboratories, doctors, laboratory technicians, nurses and pharmacists who are specifically involved in the study.
Microscopic parasite count before treatment (H0) was 31,714/µL, D1 was 2400/µL, and D2 was 372/µL.The result of platelet examination D0 was 94 x 10 3 /mm 3 , D14 was 297 x 10 3 /mm 3 , D28 was 186 x 10 /mm 33 (normal platelet value: 150-400 thousand / mm 3 ).Laboratory examination results of total bilirubin value D0 by 1.3 mg%, D14 by 0.6 mg%, D28 by 0.3 mg% (normal value of total bilirubin: 0.2-1.0mg%).D0 charantia) is able to improve platelet values, reduce and eliminate P. falciparum parasites followed by a decrease in clinical symptoms.This is in line with the research of Syamsudin et al in Manokwari, West Papua showing that the combination of bitter melon extract with primaquine was able to eliminate clinical symptoms that arose at D7 and improve platelet values at D14, D28, and D42. 6Al Salahy et al's research in Yemen showed that parasite density affects the value of total bilirubin and direct bilirubin.Patients with parasitemia tend to have low total charantia) extract needs to be followed by the use of anti-nausea and vomiting drugs to optimize therapeutic efficacy.It is likely that bitter melon fruit extract causes nausea and vomiting in patients with the results of measuring the Naranjo scale the total score is 6.Syamsudin et al research on uncomplicated Plasmodium falciparum malaria patients using a combination of bitter melon fruit extract (Momordica charantia) and primaquine in Manokwari, West Papua clinical symptoms of nausea on day 7 and vomiting on day 3 were reported to disappear.6