Litchi, Cause of Encephalitis outbreak in Muzaffarpur, Bihar?

Last updated on June 20th, 2019 at 12:50 pm

Recent unfortunate 100+ death of kids under 10 years of age at Muzaffarpur, Bihar is found to be due to Acute Encephalitis Syndrome. The reason is thought to be mix of malnutrition, heat & litchi.

But there is also another term known as Hypoglycemic encephalopathy which is the actual cause of so many deaths in Muzzafarpur, Bihar. Acute Encephalitis Syndrome is a broad term to describe the clinical neurological conditions such as fever, convulsion, disorientation, delirium or coma in children.

So, is there any difference between encephalitis syndrome and hypoglycemic encephalopathy? How a common edible fruit litchi can cause hypoglycemic encephalopathy?

But before we answer these, here’s an extract from The Times of India, June 18, 2019: “Bihar went deeper into the grip of a deadly fever whose colloquial name -chamki bukhar-hid the disease’s ferocity. Worried state government official said 103 children, almost all of them below 10, had died by Monday from what medically is known as acute encephalitis syndrome. Read full article.

What’s Acute Encephalitis Syndrome (AES) & Hypoglycemic Encephalopathy?

In Acute Encephalitis Syndrome (AES) the brain cell becomes inflamed due to infection of viruses, bacteria, fungus, parasites, spirochetes.

It is a broad term to describe inflammation of brain cell and associated neurological symptoms such as:

• Fever.
• Drowsiness, lethargy, and possibly coma.
• Personality changes, irritability, or emotional outbursts.
• Weakness in one or more areas of the body.
• Seizures.

Encephalopathy refers to permanent or temporary brain damage, disorder, or disease. It affects the brain’s function or structure and may be degenerative. The cause of encephalitis is chemical and toxins.

When encephalopathy happens due to a decrease in blood sugar level then it is termed as hypoglycemic encephalopathy. And hypoglycemic encephalopathy is the cause of outbreak in Muzaffarpur, Bihar.

In hypoglycemic encephalopathy, due to the consumption of any toxins, there is a sudden drop in the level of glucose < 50 mg/dl in the brain. As a result, the person goes through an altered mental status, seizures, coma. However, children with malnutrition, the elderly, and those with a weak immune system are most vulnerable.

Muzaffarpur AES outbreak is linked with litchi and there is several previous study and research to support this

Litchi associated acute hypoglycaemic encephalopathy 

Lithci is summer fruit that sweet to taste and looks bit like strawberry from outside. Though its outer is thin and hard, inside pulp is transparent white in color. Muzaffarpur is popular for its lithci cultivation.

In 2012-2013, a research team headed by Dr. T. Jacob John found that litchi contains a chemical, methylene cyclopropyl glycine (MCPG) , which is a hypoglycaemic agent (which causes to reduce glucose level). According to the report the disease is caused by litchi consumption after a prolonged fast by undernourished children.

Due to the presence of a hypoglycaemic agent, methylene cyclopropyl glycine (MCPG), eating litchi in the empty stomach of malnourished children causes a sudden drop in glucose level in the brain leading to stupor and coma.

Is hypoglycemic encephalopathy treatable?

Yes, it can easily be treated by restoring the glucose level by infusion of 10 % dextrose with 3% saline within four hours after the onset of symptoms.

Resource:

1. AES toll 103, mix of malnutrion, heat & litchi behind kids death. (TOI news), https://timesofindia.indiatimes.com/city/patna/muzaffarpur-acute-encephalitis-syndrome-toll-mounts-to-103-with-10-more-deaths/articleshow/69828920.cms
2. Lychee-associated acute hypoglycaemic encephalopathy outbreaks in Muzaffarpur, https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30269-3/fulltext#back-bib1