Acute Encephalitis – Major challenge for India

As the death toll of children dying from Acute Encephalitis Syndrome (AES) in Bihar’s Muzaffarpur crosses 130 in over two weeks, it brings back disconcerting memories from Gorakhpur, about two years ago.

Over 70 children had died in a matter of days at Uttar Pradesh’s Gorakhpur, a tragedy that raised questions involving the government hospital where it occurred, its doctors and the alleged short supply of oxygen cylinders.

The two incidents are similar, as they reflect the State’s lack of preparedness to tackle seasonal encephalitis, say experts, urging health authorities to have standard operating procedures (SOP) that kick in before the worrisome months arrive.

And yet, Muzaffarpur’s outbreak is different, as it is not the classical infectious encephalitis that occurs in some States in the monsoon months. Over the years, the mid-summer encephalitis outbreak in this region has been linked to a toxic ingredient in the lychee fruit coupled with low blood sugar in children. Though lychee has many good properties, problem arises when children have it on an empty stomach. 

Litchi does not cause any harm in well-nourished children, but only in undernourished children who had eaten litchi fruit the previous day and had gone to bed on empty stomach. This can be prevented in malnourished children. Making sure that undernourished children do not eat plenty of litchi fruit and ensuring that they eat some food and not go to bed on empty stomach can easily keep the disease at bay. Since 2015, the prevention strategy as recommended by Dr. Jacob John’s team helped in sharply reducing the number of deaths in Muzaffarpur. In 2017, the Indo-U.S. team published their paper corroborating these findings and recommendations.

Acute encephalitis is an inflammatory condition of the central nervous system. It is a complex and severe disease. Acute encephalitis can be caused by a wide variety of conditions, including:

  • Bacterial or viral infection in the brain
  • Ingestion of toxic substances
  • Complication of an infectious disease
  • Complication of an underlying malignancy

In 2012-2013, a two-member team headed by virologist Dr. T. Jacob John suspected, and next year confirmed, a toxin found in litchi fruit that was responsible for causing such diseases. In 2017, a large Indo-U.S. team confirmed the role of the toxin. The toxin is called methylene cyclopropyl glycine (MCPG).

As toll of acute encephalitis syndrome (AES) mounts in Bihar, the neighbouring state Jharkhand has put its medical services on alert. Sceptical over possibility of the Encephalitis outbreak in Jharkhand, the state government has asked all the medical colleges, hospitals, institution and civil surgeon to remain on high alert to deal with any emergency. A closed door seminar was organised at the Rajendra Institute of Medical Sciences in Ranchi to sensitise doctors about the symptoms of disease which has claimed the lives of over 100 children in Bihar this month.

Odisha government ordered laboratory test of litchi fruit being sold in the markets in the state.The government’s action came after reports that litchi consumption was one of the factors behind the spread of AES. Bihar’s Muzaffarpur district was one of the litchi growing areas in the state where more than 100 children have died so far due to acute encephalitis syndrome (AES).

IPD sincerely hopes all possible remedial steps are taken and India becomes more equipped in fighting this disease.

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