The outbreak of Acute Encephalitis Syndrome (AES) has so far led to the deaths of 150 children in Muzaffarpur, Bihar. But the cause of the disease remains unclear.
The deaths are being attributed to various causes - from heat, humidity, dirt, malnutrition, sleeping on an empty stomach, to eating litchis from gardens.
However, a team of doctors from the Indian Medical Association that visited Bihar has said that litchis could not have caused the deaths, as even infants are affected.
Amidst all this, a message has been floating on social media that claims that if you feed your children litchis, they can get the ‘chamki fever’ (brain fever or encephalitis).
Experts Say Malnutrition is the Real Culprit
Dr. Rafat Trivedi, Consultant Pediatric Neurologist at Max Hospital, Gurgaon, speaks about the possible relation between encephalitis and litchis:
Litchis contain a toxin, methylenecyclopropylglycine (MCPG), which decreases the blood sugar levels of the body. If malnourished children eat raw (unripe) litchis or a lot of litchis, they can get hypoglycemia (low blood sugar).
Dr. Trivedi explains that our liver contains glycogen which breaks down into glucose when required. This helps in maintaining the glucose levels in our body. But, due to malnutrition, the livers of these children are not able to store sufficient glycogen. When the toxin enters the body, liver fails to make glucose.
We can’t confirm that the deaths are caused by litchis. But we can definitely say it has something to do with malnutrition. So, malnutrition should be our target.Dr. Rafat Trivedi
Production Of litchi In India
According to the National Research Center on Litchis, the fruit was introduced to the North-Eastern states of India from Burma in the 17th century. Today, litchi is grown in Bihar, Jharkhand, Chhattisgarh, Punjab, Tripura, West Bengal, Assam, Uttarakhand, Orissa and Himachal Pradesh.
Apart from these states, litchis are also grown in Jammu and Kashmir, Manipur, Meghalaya, Nagaland, Sikkim, Kerala and Tamil Nadu. 40 per cent of the total produce of litchis in the country comes from Bihar. Muzaffarpur is famous for its ‘shahi litchi.’
Litchis and Encephalitis
In India, Japanese Encephalitis Virus (JEV) was considered as the main cause of encephalitis. But, in 2014, a new idea was proposed that said the cause of encephalitis in Muzaffarpur, Bihar was the toxin found in litchis.
In these cases, although encephalitis was not confirmed, pathogenesis lead to encephalopathy with hypoglycaemia. The term ‘encephalopathy’ is used for brain diseases that alter brain structure and functions.
A toxin, methylenecyclopropylglycine, was found in the seeds of litchis. Researchers from US Center for Disease Control attributed the deaths to this toxic substance.
However, experts at the National Center for litchi in Muzaffarpur, which is under the Indian Council of Agricultural Research (ICAR), have shunned this theory.
Was Litchi Consumed by All?
Shadab Moizi, from The Quint, in a conversation with the parents of the patients in Muzaffarpur, found out that not all children who fell ill ate litchis.
Shadab reported that some parents also told him that they did not have enough money to feed their children with expensive fruits like litchi.
Litchis and Hypoglycemia
The cause of 80 per cent of the total deaths in Muzaffarpur is said to be hypoglycemia.
According to a study by the National Center for Disease Control and US Center for Disease Control and Prevention, which was published in The Lancet Journal in 2017, children who lived in villages and were affected by the disease would eat litchis in the day and would sleep at night with an empty stomach. litchis contains hypoglycin A , which leads to decrease of blood sugar levels in children overnight. This becomes a reason for hypoglycemia.
People all over the world have been eating litchis for hundreds of years. While, this disease has been affecting children in Muzaffarpur only for the past couple of years. Associating this disease with litchi is misleading. There has been no study or facts to prove that the fruit is the culprit.Vishal Nath, National Research Center on Litchi
Amidst all this, Prem Kumar, Health Minister for State of Bihar, has given orders to find out whether litchis is the real culprit or not. The minister has ordered that agricultural scientists and horticulture officials should take a tour of the affected areas.