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From Heat to Malnutrition: What’s Causing the Deaths in Bihar?

More than 50 children have died in Bihar after suffering with high fever. What is causing the fever and deaths?

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Fit
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In the last couple of days, more than 60 children have reportedly died in Bihar after getting high fever. While some died in the hospital, others died before they could undergo any treatment.

A fever, locally known as the ‘chamki bukhar’, has caused panic in and around Bihar's Muzaffarpur. The name is used to refer to encephalitis or brain fever, characterised by inflammation of the brain.

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Cause of Encephalitis

Speaking to FIT, Dr Chandril Chugh, Senior Consultant and Head, Interventional Neurology, Max Super Speciality Hospital, Saket, shared that between 2008 and 2014, there have been more than 44,000 cases and nearly 6,000 deaths from encephalitis in India, particularly in Uttar Pradesh and Bihar.

“Most of the encephalitis instances are viral in origin, although bacterial infections are also known to cause encephalitis. It is still not clear as to which virus or etiology is causing the encephalitis in Bihar, but most likely culprit seems to be a virus.”
Dr Chandril Chugh

Factors like the season and location have a role to play in the incidence and severity of the disease.

Some common symptoms of encephalitis, as mentioned by Dr Chugh are drowsiness, confusion, lethargy, decreased feeding, headaches, seizures or fits, inability to respond, fever, neck pain or stiffness, or weakness on one side of the body.

More than 50 children have died in Bihar after suffering with high fever. What is causing the fever and deaths?
JEV-Japanese Encephalitis Virus, CHPV-Silverpura Virus, NiV-Nipah Virus
(Photo Courtesy: NCBI)

To find out the main reason for encephalitis at any place, including Muzaffarpur, the need for a strong study remains.

What Doctors in Muzaffarpur Say

Doctors and government officials have been hesitant in linking the children’s deaths to encephalitis. According to reports, they believe that hypoglycemia (loss of sugar in the blood) and shortage of sodium in their bodies have together been responsible for the unfortunate incidents, and not encephalitis.

To understand if hypoglycemia and encephalitis could be linked in any way, FIT spoke with Dr Ashwini Setya, a Gastroenterologist and Programme Director at Delhi’s Max Super Speciality Hospital.

“If someone has very high fever, several things take place inside their body. Hypoglycemia could be one of those many things.”
Dr Ashwini Setya

This could be why the children who are showing encephalitis-like symptoms are also showing signs of hypoglycemia. The doctor further clarified that hypoglycemia in itself is rarely a cause of death.

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Common Symptoms Being Observed in Kids

In conversation with FIT, Dr Shailesh Prasad Singh, Civil Surgeon of Muzaffarpur, said that the children who are unwell in Muzaffarpur indeed have low blood sugar (hypoglycemia) or deficiency of sodium and potassium. He further mentioned other conditions which have also been noticed in the unwell children.

“In most cases, it has been observed that exposure to the sun throughout the day, not eating properly, sleeping hungry at night and malnutrition have been some reasons behind the sickness.”
Dr Shailesh Singh

To understand the possible connection between hypoglycemia and these cases, it is important to know what hypoglycemia is and why it happens.

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What is Hypoglycemia?

According to Mayo Clinic, it is a condition caused by a very low level of blood sugar (glucose) which is the body's main energy source. It is often associated with diabetes.

However, several conditions — many rare — can cause low blood sugar in people without diabetes. 

The report further adds that like fever, hypoglycemia isn’t a disease itself. It is an indicator of a health problem.

Not eating for a long time can lead to deficiencies in the body of essential nutrients that are important to generate glucose. This may cause hypoglycemia. Similarly, the lack of growth hormone in children can also lead to the condition. 

When blood sugar is at 70 mg per deciliter, hypoglycemia needs immediate treatment. This would require high-sugar food and drinks or medicines.

Not treating it can result in seizures, unconsciousness and in severe cases, death.

Litchi and Encephalitis

Bihar’s Muzaffarpur is popular for its litchi. Every year since 1995, the incidence of encephalitis has been coinciding with the litchi season.

In 2014, the Indian Academy of Pediatrics’s article titled ‘Misery of Mystery of Muzaffarpur’ stated that some experts had hypothesised the link between litchi and the city’s brain fever from April to July.

However, experts from Muzaffarpur-based National Research Center for Litchi under the Indian Council of Agricultural Research (ICAR) have completely refuted the litchi theory claiming zero link, based on toxicology tests.

On the potential link between litchi and hypoglycemia, nutritionist Vishruta Biyani wrote for FIT, “Avoid eating litchi, especially the unripe ones, on an empty stomach since they contain hypoglycin A and methylenecyclopropyl-glycine (MCPG); these toxins may result in vomiting and fever. Hypoglycin inhibits the body's ability to produce glucose and may cause hypoglycemia.”

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The Path Ahead

According to media reports, the Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna and National Center for Disease Control (NCDC) will take special initiatives to detect the main reason behind the encephalitis-like symptoms. Team of RMRI Patna's experts will visit the affected villages of Muzaffarpur and conduct studies on the living standards and food intake of the children there.

Expressing some hope, Dr Shailesh Singh said that relief from heat and humidity is likely to decrease such cases. “The situation should improve after the 12 June rains”, he added.

(This story was originally published on Fit Hindi. It has been translated to English by Saakhi Chadha)

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