Herbal ‘cures’ for multi-drug resistant typhoid fever

SeveralL studies have identified plants that could be effectively used singly or in combination to treat multi-drug-resistant (MDR) strains of typhoid fever (caused by Salmonella typhi).

Top on the list are Azadirachta indica (neem tree), Ocimum gratissimum (scent leaf), Carica papaya (pawpaw) and Morinda lucida. Morinda lucida belongs to the plant family Rubiaceae. It is commonly called Brimstone tree. It is Oruwo or Erewo in Yoruba, Eze-ogwu or Njisi in Ibo.

Botanically called Ocimum gratissimum, scent leaf or Basil belongs to the mint family Lameacea. It is called effirin in Yoruba and nchuanwu or arigbe in Ibo. Earlier studies had demonstrated how a herbal preparation made predominantly with garlic, ginger, onions, scent leaf, lemon grass, unripe pawpaw, lime/lemon, African pepper (Uda in Igbo), clove, Gongronema latifolium (Utazi in Ibo, Arokeke in Yoruba) and West African Black pepper (Uziza in Igbo) could be effectively used to prevent and treat malaria and typhoid.

Meanwhile, a recent study published in the Journal of Herbal Pharmacotherapy found that extracts of Morinda lucida and Ocimum gratissimum were active against MDR S. typhi. The study is titled “Screening of Some Medicinal Plants Used in South-West Nigerian Traditional Medicine for Anti-Salmonella typhi Activity.”

The researchers wrote: “Ten Nigerian medicinal plants used traditionally for the treatment of several ailments of both microbial and non-microbial origins were tested on multi-drug resistant S. typhi (MDR) strains of which six of them were active.

“The results revealed that both the aqueous and ethanol extracts of Terminalia avicennioides, Momordica balsamina, Combretum paniculatum and Trema guineensis were effective on the MDR-S. typhi strains with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values ranging from 9.60 to 14 mcg/ml and 24 to 33 mcg/ml, respectively.

“Whereas, only the aqueous extracts of Morinda lucida and Ocimum gratissimum were found to be active against this pathogen with MIC and MBC values of 9.60 and 24 mcg/ml for M. lucida, 40 and 55 mcg/ml for O. gratissimum, respectively. There was no statistical significant difference (P > 0.05) between the activity of each plant extract and the decoctions prepared from them.

“All the six active plants showed positive reactions to alkaloids, tannins, flavonoids and anthraquinones but in variable degrees. All but M. balsamina, indicated the presence of saponin.”Another study published in the International Journal of Tropical Disease concluded: “In all, 34 different plant species belonging to 25 families were found to be present in these products. A literature search on the plants species showed that their traditional use in the treatment of typhoid is well documented and hence their resulting formulations may as well be very effective.”

The study titled “Herbal Medicines Used in the Treatment of Typhoid in the Ga East Municipality of Ghana.” The researchers investigated anti-typhoidal herbal medicinal formulations that are for sale on the Ghanaian market with regards to the contents on the product labels and assesses the various active plant components in the light of documented evidence of their use in the treatment of typhoid.

Herbal products for the treatment of typhoid were sampled from herbal medicine shops and pharmacies and assessed for the type of formulation, plant and non-plant constituents, dosage, indications, treatment duration and contraindications.

According to results of the study, majority of the products (87 per cent, n=16) had registration numbers whilst 13 per cent had none. These anti-typhoid formulations were simultaneously recommended for the treatment of malaria
(56 per cent that is nine out of 16 products), jaundice (31 per cent), various types of pains (body pains, headache, menstrual pains) (eight per cent), stress (eight per cent) and fatigue (eight per cent). All the preparations had more than one plant as its active constituent.

The results showed 44 per cent contained two plants species as the active ingredients, 37 per cent contained between three to five plant species, 13 per cent contained six to 10 plant species and six per cent contained more than 10 plant species. The most frequently occurring active plant constituents of these products were Carica papaya (pawpaw), Morinda lucida, Citrus aurantifolia (lime), Vernonia amygdalina (bitter leaf) and Azadirachta indica (neem tree).Another study published in the journal Archives of Medicine identified neem tree and licorice as effective treatment for typhoid fever.

The study is titled “Glycyrrhiza glabra and Azadirachta indica against Salmonella typhi: Herbal Treatment as an Alternative Therapy for Typhoid Fever” concluded: “The present study showed the traditional roles of plants in curing typhoid. Methanolic extract of Glycyrrhiza glabra and Azadirachta indica have broad-spectrum antibacterial activity against gram positive and gram-negative bacteria.

The study support the use of these herbal extracts as to prevent or control the typhoid, and anti-typhoid activity of these medicinal plants are promising to act as potential agent for treating typhoid fever from natural plant source.”

The researchers from the Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan analysed an in-vitro anti-bacterial activity of methanolic extract of Glycyrrhiza glabra (licorice) and Azadirachta indica (neem tree) against two gram positive and three gram negative organism by using disk diffusion method at the concentrations of 20 ppm, 30 ppm and 40 ppm. The zones of inhibition were measured with mm scale and found in the range of 6 mm to 17 mm.

The result revealed that methanolic extract of both plant posses anti-bacterial activity. These plant extracts may prove their promising role as antibiotics and may help to overcome the problem of resistivity against many pathogens. Moreover, anti-typhoid activity of these medicinal plants is promising to act as potential agent for treating typhoid fever from natural plant source.

The traditionally used medicine, Glycyrrhiza glabra and Azadadirachta indica having antibacterial activity also reported. Glycyrrhiza glabra also known as Licorice and sweet wood belong to the family Papilionaceae. It contains saponin glycoside that is glycyrrhizin, flavonoids and many other constituents.

Azadirachta indica commonly known as Neem, belong to the family Meliaceae (mehogani family). Neem seeds contain azadirachtin, alkaloids, flavonoids, triperpenoids, phenolic compounds, carotenoids, steroids and ketones. In 2012, a phytochemical constituents, pharmacological action and medicinal use through the millennia of Glycyrrhiza glabra were conducted and it was accomplished that it is used as a traditional medicine, it contain glycyrrhizin and other chemical constituents extracted from root of licorice. It is used as a prophylactic as well as therapeutic drug for major body ailment sat any age group. In 2013, the phytochemical screening and anti-oxidant potential of Glycyrrhiza root extract was conducted, it was concluded that it have significant anti-bacterial and hydroxyl radical scavenging activities, it is helpful in treating bacterial infection and scavenging hydroxyl radical which are generated during carcinogenesis. In 2012, the antimicrobial activity of leaf extract of neem was conducted against Pseudomonas aeroginosa, Staphylococcus aureus, Salmonella typhii and Baccilus pumillas and concluded that ethanol and methanol extract show maximum inhibition on Baccillus pumillas, Pseudomonas aeruginosa and Staphylococcus aureus in ascending order.

Currently, typhoid fever is a major health problem in developing countries with limited success of treatment with antimicrobial agent. The previous study evaluated the anti Salmonella typhi activity of ethanol, hot and cold crude water extracts of Vitex doniana (root), Cassia tora (leaf), Alstonia boonei (bark), Stachytarpheta jamaicensis (leaf), and Carica papaya (leaf) used as traditionally medicine in Ebonyi state, Nigeria. The neem seeds extract and glycyrrhiza extract shows comparable same result as compare to ampicillin. The plant extract as naturally synthesize mostly preferable because of having no destructive effects. The frequent use of antimicrobial agent is restricted because the frequent use may cause resistivity, Gastrointestinal (GI) upset and loss of appetite.

The tested methanol extracts of Glycyrrhiza glabra and Azadirachta indica have profound antimicrobial activity against both gram positive and gram-negative bacteria. The valuable zone of inhibition of both extract is especially against Salmonella typhi. The result clearly shows that the herbal extract of both plants shows the same zone of inhibition as compare to controlled drug ampicilin. The quantitative and qualitative differences in inhibition variation are influenced by the method of extraction and concentration.

In this study using the disc diffusion method, which is widely acceptable for preliminary screening of plant extracts, tested the anti-bacterial activity. It is essentially an initial test indicating the sensitivity and resistivity of microorganisms to the test sample. It became also clear in the current study that concentrations affect the degree of antimicrobial activity, as the concentration increases the antibacterial activity also increases.

The researchers wrote: “Various plant shows inhibitory effect on the growth of bacteria and also effective for systemic diseases, and our finding also prove that both plant extracts have great potential as antimicrobial activity against enteric bacterial pathogens and they can be used in the treatment of communicable diseases with no destructive effects. The data obtained in this study justify the use of herbal preparations of neem and liquorice in typhoid. It is concluded from the result that both plant extracts have anti-bacterial activity against Salmonella typhi and they can be used in typhoid fever as alternate medicine in order to prevent antimicrobial resistivity. Currently, we reported experimental proof of the same. Further research should be preceded to go into more detail studies to find out the bioactive constituents.”

The researchers concluded: “The present study showed the traditional roles of plants in curing typhoid. Methanolic extract of Glycyrrhiza glabra and Azadirachta indica have broad-spectrum antibacterial activity against gram positive and gram-negative bacteria. The study support the use of these herbal extracts as to prevent or control the typhoid, and anti-typhoid activity of these medicinal plants are promising to act as potential agent for treating typhoid fever from natural plant source.”

Yet another study published in the International Journal of Recent Trends in Science And Technology, reviewed plants as a source of novel anti-typhoid therapeutic agents. The Indian researchers from the Department of Biotechnology, College of Computer Science and Information Technology, Latur 413512, Maharashtra, and Department of Biotechnology, Government Institute, Aurangabad, Maharashtra, india noted: “Typhoid fever is now becoming the deadly danger disease day by day because of the resistance power developed by Salmonella typhi, Salmonella paratyphi A, Salmonella paratyphi B; which cause typhoid fever, paratyphoid A and B fevers respectively. This situation has created a need to find more effective drugs.

“Natural products from microorganisms have been the primary source of antibiotics, and with the increasing acceptance of herbal medicines, the screening of medicinal plants for new active compounds has become a very important source of novel antibiotics.

“Alternative herbal medicine has been used to treat various infections from centuries. Natural plants contain phyto-constituents having similar chemical properties as of synthetic antibiotics. In future plants may be the source of effective treatments against typhoid and many more diseases.”

The researchers identified among others:
*Formulation A comprising Cymbogogon citratus (lemon grass) leaves, Carica papaya (pawpaw) leaves, and Zea mays (corn) silk.
*Formulation B comprising C. papaya roots, Mangifera indica (mango) leaves, Citrus limon (lemon) fruit and C. citratus leaves.