|Year : 2022 | Volume
| Issue : 2 | Page : 53-57
Post-COVID eosinophilia – A report on its Ayurvedic management
Manjiri Jayprakash Walinjkar, Mandip Goyal
Department of Kayachikitsa, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
|Date of Submission||26-Feb-2022|
|Date of Acceptance||01-Jun-2022|
|Date of Web Publication||28-Jun-2022|
Dr. Manjiri Jayprakash Walinjkar
Department of Kayachikitsa, 4th Floor, New Institute Building, Institute of Teaching and Research in Ayurveda, Opp. B-Division Police Station, Gurudwara Road, Jamnagar, Gujarat
Source of Support: None, Conflict of Interest: None
Eosinophilia is one of the common laboratory findings of Post-COVID syndrome with lingering symptoms such as cough, dyspnea, chest discomfort, and wheezing. This can be correlated with Vataja kasa by Ayurvedic point of view. Conventional management can control raised eosinophilia and provide symptomatic relief, but relapses are often observed. A 40-year-old male patient has been diagnosed with Post-COVID eosinophilia based on his presenting complaints. He was given Chatushashti prahari pippali as an intervention. After completion of eight weeks of the treatment, the patient got complete symptomatic relief and no symptoms relapsed during the follow-up period of eight weeks and patient's increased eosinophilic count turned down to its normal limits. The observations infer that the Chatushashti prahari pippali has significant benefits in Post-COVID eosinophilia. This illustrates that there is a wide scope to explore the variety of imperative medicines present in Ayurvedic pharmacopoeia, which can be used more rationally to treat various Post-COVID complications.
Keywords: Chatushashti prahari pippali, eosinophilia, post-COVID syndrome
|How to cite this article:|
Walinjkar MJ, Goyal M. Post-COVID eosinophilia – A report on its Ayurvedic management. J Ayurveda Case Rep 2022;5:53-7
| Introduction|| |
A subset of people who have recovered from COVID-19 goes on to experience symptoms that remain beyond testing negative for the virus. These individuals are referred to as “COVID long-haulers” and the condition is termed “Post-COVID Syndrome.” According to the WHO, the prevalence rate of Post-COVID syndrome is 20% worldwide. Post-COVID is a new, distinctive phenomenon, also the symptoms of post-COVID are diverse. Hence, one-to-one correlation with Ayurvedic diseases is not possible. However, primarily being a respiratory disorder, it falls under the category of Pranavaha srotovikara (~disorders of the respiratory system), and also according to the resemblance of symptoms it can be correlated with various Ayurvedic diseases such as Jeerna jwara (~chronic fever), Punaravartak jwara (~ relapsing fever), Kasa (~cough), Shwasa (~dyspnea), and Kshatashina (~thoracic trauma).
Eosinophilia is a complication of COVID-19; as there is the risk of eosinophil-associated immunopathology following SARS-CoV-2 infection or vaccination because these induce high-affinity neutralizing antibodies stimulating type-1 immunity, might be helpful with respect to sufficient CD4+ T-cell which helps for antibody production as well as suppressing unwanted type-2 immunity causing eosinophilia. Considering this, the condition is termed as Post-COVID eosinophilia.
Eosinophilia is a condition characterized by increased absolute eosinophilic count (AEC) >500/μL of blood with bronchitis and/or leukocytosis. Allopathic treatment of eosinophilia consists of diethylcarbamazine for at least three weeks despite which about 12%–25% of patients may relapse. Another limitation of this treatment is, after the oral course of diethylcarbamazine, AEC comes under the normal limit but it does not give symptomatic relief at times. Further, it has been reported that, even though there is no reduction in AEC, Ayurvedic drugs give complete relief in subjective parameters. This reported case serves as novel evidence in the management of Post-COVID eosinophilia with Ayurvedic intervention.
| Patient Information|| |
A 40-year-old male, married, non-addictive patient working at Reliance industry consulted in the outpatient department (OPD) on July 15, 2021, for chief complaints of dry cough, sore throat, anorexia, grade I dyspnea, nocturnal wheezing, and occasional constipation since May 2021.
The patient was having symptoms such as fever, cough, dyspnea, and malaise from April 6, 2021, and found positive for COVID-19 [positive Reverse Transcription–Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2] on April 8, 2021. He took allopathic treatment and was in home isolation for 14 days. His vitals including O2 saturation were stable during the period of acute COVID infection. According to the patient, the source of infection was his colleague at workplace who was COVID-positive and the patient was in close contact with him. Apart from this, there was no history of any comorbidity such as hypertension, diabetes, surgical intervention, or any other major illness, etc.
Detailed history of present illness
After the treatment for acute COVID-19 during home isolation; the symptoms such as fever, malaise, and productive cough got subsided but occasional dry cough and mild dyspnea persisted. The patient stopped the medication after 14 days and ignored other persisting symptoms. When the dry cough worsened with the development of sore throat and anorexia, he again consulted for allopathic treatment but did not get expected relief and hence consulted here for Ayurvedic management.
Nature of the cough was dry, nocturnal, paroxysmal, and distinctively worsening after two hour of dinner. Exacerbating dyspnea on inclination or hurrying on level ground; hence it was categorized as grade 1 dyspnea. Sore throat was on and off. The patient was having anorexia, although he was taking food twice a day despite his aversion of food. He was developing constipation mostly after the night shift.
During home isolation, the patient took antibiotics (cefixime and azithromycin) for 5 days, multivitamins (zincomin) for 14 days, corticosteroids (ventocortil) for 10 days, antacid (Rabewill DSR) for 14 days, and antihistamines (levomont) for 10 days for the management of COVID-19 infection and was under the supervision of a conventional physician.
After 14 days, he stopped all these medicines. As few mild symptoms were persisting for the next 15 days, he consulted again to allopathic physician and got prescribed levomont (levocetirizine and montelukast combination) for 15 days. However, did not get significant relief. After that, he consulted for Ayurveda treatment. On day one of his consultation, he was taking levocetrizine10 mg once at night.
The mother and father of diseased are alive without any comorbidity. The patient's wife also got infected with COVID-19 during the same period he was. He has a 7-year-old healthy child. No other comorbidities were reported by the patient.
| Clinical Findings|| |
On presentation to the OPD, the examination of the patient revealed the following findings:
Detailed case history revealed that the patient was taking Ahara (~food) three times/day of mixed type. As he was doing shift duty, many times taking Vishamashana (~consuming less or more quantity of food at improper time). His Agni (~digestive/metabolic factors) was Samyak (~appropriate), Koshtha (~nature of bowel) was Krura (~irregular or constipated bowel nature), Mala (~stool) was Nirama avastha (~devoid of Ama) but sometimes required Pravahana (~straining to defecate), Mutra (~urine) was Samyak, Nidra (~sleep) was Samyak, Jivha (~tongue) was Nirama, and work schedule was sedentary, stressful, and having shift duty.
Dashavidha pariksha (~Tenfold examination)
The Prakriti (~physical constitution) of the patient was Vata-pittaja (~predominant of Vata and Pitta), Vikruti (~morbidity) was Vatapradhana (~predominant of Vata), and Sara (~excellence of Dushya or tissue elements), Pramaana (~measurement of body constituents), Saatmya (~homologation), and Vayah (~age) were Madhyam (~medium). Samhanana (~compactness of tissues or organs) and Satva (~psycic condition) were Pravara (~good); The Aharashakti (~power of intake and digestion of food) Vyayama shakti (~power of performing exercises) of the patient were Avara (~less).
On presentation to the OPD, the patient weighed 50 kg with a Body Mass Index (BMI) of 19.53 kg/m2. His blood pressure was 110/82 mm/Hg, heart rate was 88 pulse/min, and respiratory rate was 20/min having 98.4°F temperature and 98% SpO2.
On the systemic examination, no pallor, icterus, cyanosis, clubbing, lymphadenopathy, or edema were found. On respiratory system examination, the patient's chest shape was observed normal with air entry bilaterally equal and no crepitus, bronchi, or added sound found. No abnormality was detected on Cardio Vascular System (CVS), Central Nervous System (CNS), and per abdomen examination.
At the screening visit, his RT-PCR was negative, no abnormality was detected in posteroanterior view of chest X-ray, and the electrocardiogram was within normal limits. His complete blood count reveals 13.8 gm% hemoglobin, white blood cell was 5980/cu.mm, neutrophils were 69.6%, lymphocytes were 16.9%, eosinophils were 6.7%, monocytes were 6.5%, basophils were 0.3%, absolute eosinophilic count was 620.66/μL, erythrocyte sedimentation rate was 30 mm/h, and RBS, lipid profile, LFT, and KFT were within normal limits.
| Timeline|| |
The timeline of the present case is depicted in [Table 1]. The patient showed maximum compliance toward the treatment. The diagnostics assessments showed significant improvement.
| Diagnostic Assessment|| |
The symptoms present in the patient were assessed as subjective parameters. The eosinophilic count was compared before and after treatment as an objective parameter.
| Therapeutic Intervention|| |
After obtaining written consent, the patient was prescribed to take a capsule Chatushashti prahari pippali (500 mg) twice a day with lukewarm water after meal for eight weeks. Furthermore, the patient was advised to stop the allopathic medicines that he was taking earlier.
| Follow-Up and Outcomes|| |
After eight weeks of treatment, complete improvement was observed in all the subjective parameters. The eosinophilic count was within normal limits. No symptom was observed to be relapsed even during the follow-up period. Improvement in subjective parameters is tabulated in [Table 2]. Differential eosinophilic count reduced to 2.6% from 6.7% while absolute eosinophilic count reduced to 128.18/μL from 620.66/μL.
| Discussion|| |
No description of post-COVID syndrome and related manifestations is available in Ayurveda texts. The current manifestation is correlated with Vataja kasa, considering the symptomatology.
Regarding this case; one can consider Rajodhumanila sevana (~exposure to dust, smoke, and wind) as extrinsic factors responsible for the infection. Due to his shift duty, he was always doing Vishamashana and had a history of suppressing natural urges. His work was stressful and reported feeling fatigue at the end of the day. Thus, the causative factors found in this case are Rajodhumanilasevana, Vishamashana, Vegadharana (~suppression of natural urges), and Aayasa (~exertion).
Cough worsens at night, particularly after 2 h of dinner is specific in this case, which can be correlated with characteristics of Vataja Kasa, that exacerbate after the digestion of food. Diurnal variations in the eosinophilic count are well reported. The lowest count is observed in the morning, whereas the highest count may be seen at the night. Thus, worsening of symptoms at night.
Further, parasitic or viral infection may cause pulmonary infiltrates leading to eosinophilia. Pulmonary eosinophilia is considered endemic in India. It is predominant in the coastal region. It is more likely to occur in nonimmune individuals and in persons who traveled to the endemic regions. Jamnagar is also a subcoastal region of India and it may be an endemic region for eosinophilia. The patient in this case is not a permanent resident of Jamnagar. He is in Jamnagar for the job purpose for one and half years possibly this factor also might trigger the pathology.
Pippali (Piper Longum Linn.) is one of the Rasayana (~rejuvenation) drugs, which helps in the management of diseases of Pranavaha srotas. Chatushashti prahari pippali is made by triturating Pippali churna with Pippali kwatha (~decoction) for 64 Prahara (192 h). Textual indications of Chatushashti prahari pippali are Vata and Kapha disorders, Kasa, Shwasa, Agnimandya (~diminution of digestive fire), Aruchi (~tastelessness), Amlapitta (~hyperacidity), Shoola (~pain), Kaphaja jwara (~fever due to dominance of Kapha), and Jeerna jwara.
Pippali having Katu (~pungent), Tikta (~bitter) Rasa (~taste); Madhura (~sweet) vipaka (~bio-transformed rasa); Anushna veerya (~potency), Laghu (~lightness), Snigdha (~unctuousness), and Guna (~properties) works as Vata-kaphahara (~alleviate Vata and Kapha), Deepana (~digestion and metabolism-enhancing), Hridya (~beneficial for health), Vrishya (~aphrodisiac), Rasayana, etc. By its Madhura and Snigdha properties, it alleviates Ruksha (~dryness), Khara (~roughness), Laghu and Sukshma (~penetrating) properties of Vata. By its Ushna (~hotness) and Tikshna (~sharpness) properties, it assuages Sheeta (~cold) property of Vata. By Katu rasa and Snigdha property, it diminishes Chala property of Vata. In Kasa, the Prakritagati (~usual movements) of Vata is affected. Pippali is also Anulomaka (~mild purgative action) by its Madhura, Ushna, and Snigdha property thus maintaining the usual direction of Vata. By virtue of these, Pippali is useful in Vataja kasa.
It is a potent rejuvenating herb and has antiviral, antibacterial, antifungal, and anti-inflammatory properties., It is also a good analgesic, and alleviates anxiety.
It has antagonizing effect in respiratory diseases,, Immune regulatory potential, phagocytic activity, and anti-asthmatic and anti-eosinophilic effects. The levocetirizine (10 mg) that he was using at the time of the first consultation at Ayurveda OPD was withdrawn during the treatment period. The patient never felt its need during the treatment period nor during the follow-up period. Considering these actions, it can be assumed that Chatushashti prahari pippali is useful in post-COVID eosinophilia and being a Rasayana, gives immunomodulatory effects.
| Conclusion|| |
Post-COVID eosinophilia can be correlated with Vataja kasa and Chatushashti prahari pippali provided can manage the condition satisfactorily. The findings of this case report can be useful for understanding the possible clinical pathology of Post-COVID eosinophilia and the benefit of Ayurvedic intervention in the management of similar cases. Long-term studies using such Ayurvedic intervention should be carried out in large samples to assess if any recurrence in disease. An integrated approach should be adopted in prevention, management and to avoid lingering or recurrence of post-COVID complications and thus improve the quality of life.
Patient-reported complete symptomatic relief with improved quality of life and he was able to perform all his daily activities without any limitations. Before starting the treatment, he was taking allopathic medicines, but as Ayurvedic treatment started, he had left the allopathic medicines. Furthermore, after the cessation of Ayurvedic treatment, the patient did not necessitate any medicine and still, he is completely fine and his symptoms did not relapse.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]