Encephalitis in Muzaffarpur- A Combined Effect of Litchi Toxin, Malnutrition, and Heat Wave

By Neucrad Health India news desk June 18, 2019

In the summer of 2019, more than 100 small children in Muzaffarpur district of Bihar succumbed to a mysterious death. It also led to the hospitalisation of 309 children in the same region due to the illness. They experienced very high fever, severe headache, convulsions, hallucinations, loss of appetite, and vomiting. Physicians are blaming Acute Encephalitis Syndrome (AES) behind this outbreak, and the situation became so grave that Union Health Minister Dr Harsh Vardhan visited the state to take stock of the situation. According to Paediatricians a toxin methylenecyclopropylglycine, MCPG also called Hypoglycin A, is the main culprit behind this menace. A group of scientists from India and the United States confirmed its presence naturally in litchi fruit in 2017. It is the primary reason, many children from low-income families lost their lives after consuming litchi fruit. The locals are calling this fever as Chamki Bhukar’, ‘Litchi Havoc’, ‘Killer Encephalitis’, or ‘Deadly Litchi Toxin’ which is taking the shape of an epidemic in rural areas of Bihar in June 2019.

Should we only blame the litchi toxin behind the death of innocent children?

A key question which is doing the rounds of medical and administrative fraternity nowadays is, ‘Should we only blame the litchi toxin behind the outbreak of AES or there are other factors equally responsible behind this unfortunate turn of events?’. According to Dr Arun Shah, a Muzaffarpur-based paediatrician who was instrumental in the research on MCPG toxin conducted in 2016, it is absurd to blame the litchi crop for this epidemic. The causal factor behind the AES epidemic is malnutrition. Intense heat waves during the merciless May and June months are also equally responsible for this mishap.

How is malnutrition related to deaths due to AES?

According to studies, malnourished children consuming litchi fruit during day time and going to bed on an empty stomach has a higher probability of developing AES. It is because malnutrition leads to a decrease in glycogen level in the children’s liver. In the absence of an adequate level of glycogen, it breaks down to glucose in the human body. When this depletion further increases, the fat tissues of children starts breaking down and produce some harmful by-products, including ketones, which is a neurotoxin. In this condition, when kids get exposed to the MCPG toxin present in litchi fruits, there is an increased chance of developing hypoglycaemia and AES. So, if a child goes to bed with an empty stomach after consuming litchi during the day, the glucose level can fall to an alarmingly low level by the morning (sometimes to even 30 milligrams per decilitre). Parents become surprised how a child without any prior symptoms develop high fever and convulsions after waking up.

The connection between AES and malnutrition was further established when doctors found that no children from well-to-do families having adequate food during lunch and dinner developed fever. MCPG toxin selectively targeted vulnerable children from low-income families.

How can doctors deal with AES caused due to hypoglycaemia?

Though AES caused due to hypoglycaemia is fatal, in most cases, physicians can prevent death by administering dextrose (glucose) intravenously to children as soon as they show symptoms of high fever and convulsions. However, since most kids developing these signs belong to economically-challenged families in peripheral districts where there are limited medical facilities, immediate medical intervention is not possible. They take much time in getting admitted to a referral hospital with proper medical infrastructure. With the absence of prompt treatment, many kids had to lose their life to AES.

How did the Government deal with this situation in preceding years?

In 2014, a similar outbreak of AES was noticed in some areas of Bihar during the litchi season. However, medical teams could prevent death in about 74 per cent of the kids by timely administering 10 per cent dextrose within four hours of the onset of symptoms. District authorities also raised awareness among local crowds that no children should go to bed with an empty stomach. Similar preventive strategy in 2015, dropped the sick rate sharply in kids. However, this year, there was a lack of awareness among the local people, which led to this dangerous outbreak of AES.