Health experts have long been dumbfounded by the root of the encephalitis outbreak in Bihar’s Muzaffarpur district.
Recent studies have suggested that natural toxins in litchis could harm undernourished children by blocking their ability to produce enough blood sugar, which can lead to death.
The link to the fruit, however, is inconclusive, Alok Ghosh, the Muzaffarpur district magistrate, told Reuters. Ghosh said that in about half of the more than 400 known cases of encephalitis, the children had not consumed litchis.
Three medical sources at the Sri Krishna Medical College and Hospital, where some 95 patients have died, told the news agency they thought serious dehydration was likely to blame.
WHAT IS ENCEPHALITIS?
Encephalitis is an inflammation of the brain, caused by any one of a number of viruses.
Early symptoms can be similar to those of flu, with patients suffering from high temperatures or headaches. But symptoms can worsen within hours, and can include serious complications like seizures, paralysis and coma.
In Bihar, children were typically taken to hospital with fevers.
HOW COULD LITCHI CAUSE SICKNESS?
Researchers who conduced a study of 390 children who fell sick in 2014 in Muzaffarpur said that litchi contained hypoglycin A, an amino acid that can disrupt metabolism, lowering blood sugar levels, Reuters reports. That can trigger hypoglycaemia, and in extreme cases, death.
The study by National Centre for Disease Control and the US Centers for Disease Control and Prevention, added that when the brain lacks glucose, it turns to other sources of energy, which are rapidly depleted, eventually pushing people into coma.
“The synergistic combination of (litchi) consumption, a missed evening meal, and other potential factors such as poor nutritional status, eating a greater number of litchis, and as yet unidentified genetic differences might be needed to produce this illness,” the researchers said in their study, which was published in the Lancet in 2017.
Retired virologist T Jacob John also raised the possibility that cases of hypoglycaemic encephalitis in Muzaffarpur could be associated with litchi in a 2014 study published by the Indian science journal Current Science. Muzaffarpur is a major hub for growing litchis, which ripen at this time of year.
However Muzaffarpur-based paediatrician Arun Shah told Down To Earth, that this study has been “grossly misinterpreted”.
“If a healthy child eats litchi, s/he will not suffer from AES. The governments, both central and state, must accept that malnutrition is the cause,” he told the magazine.
Shah, an executive member of the Indian Academy of Pediatrics, said the fruit was not a causal factor, but a triggering one.
According to The Guardian, Shah and a team of doctors told the Bihar government in 2016 to direct parents that they must keep children away from litchi between April and June. Among their guidelines was a request to the administration to address malnutrition in the poorest families and tell parents to ensure their children eat a meal in the evening meal if they had eaten litchis during the day.
“The number of deaths fell in 2017-18 because the Bihar government began implementing these guidelines. But this year they took their eye off the ball because they were too caught up with the general election. I would say the state government is certainly guilty of shortcomings and carelessness,” Shah told the daily.
ANY OTHER HYPOTHESES?
Doctors and officials are testing children for a variety of conditions and many are divided on the cause of the disease.
But dehydration as a heat wave sweeps India could be to blame, according to medical staff in Muzaffarpur.
“In my observation it is nothing but an epidemic of heat stroke,” Gopal Shankar Sahni, the head of the Sri Krishna Medical College and Hospital’s paediatric department, told Reuters.
Officials are scrambling to contain the outbreak, but victims’ relatives say poor hospital facilities have allowed the death toll to balloon.
Two lawyers have filed a petition to the Supreme Court criticising government “inaction”, citing an inadequate number of doctors and hospital beds, according to a report by ANI.
District magistrate Ghosh told Reuters officials were running door-to-door awareness campaigns in villages by asking people to stay clean and hydrated. Other officials are ensuring children get sweets at breakfast to maintain glucose levels.
In neighbouring Odisha, the state’s health minister has asked officials to investigate the toxic content in litchi being sold in the state, ANI reported.
(With inputs from Reuters)