As you have probably heard in the news or social media that over 120 children have lost their lives suffering from Acute Encephalitis Syndrome (AES) in Muzzafarpur only and more than 400 children with AES have been admitted to various hospitals in Bihar
What is Acute Encephalitis Syndrome (AES)?
Acute Encephalitis Syndrome (AES) is the combination of Meningitis caused by virus or bacteria, encephalitis (mostly Japanese encephalitis) caused by virus, encephalopathy, cerebral malaria, and scrub typhus caused by bacteria.
In this case, AES refers to the children with clinical neurological manifestation that includes mental confusion, disorientation, convulsion, delirium, or coma.
There are various types of encephalopathy but in the present case, the encephalopathy is associated with hypoglycaemia and hence called hypoglycaemic encephalopathy with which most children have died as per the June 18th Press Information Bureau (PIB) press release, hypoglycaemia (low blood sugar level) was reported in “high percentage” of children who died in Muzaffarpur.
Is Litchi fruit responsible for the deaths of children?
In 2012-2013, a two-member team headed by virologist Dr. T. Jacob John thought, and next year confirmed, a toxin found in litchi fruit that was responsible for causing the hypoglycaemic encephalopathy.
In 2017, a large Indo-U.S. team confirmed the role of the toxin. The toxin is called methylene cyclopropyl glycine (MCPG).
Undernourished children who had gone to sleep without a meal at night develop hypoglycemia if they have eaten Litchi the previous day and the toxin MCPG blocks the pathway of glucose synthesis, called fatty acid oxidation required for the brain to work.
Litchi does not harm in well-nourished children.
How MCPG cause coma and even death in children?
The MCPG toxin works in two ways to harm the brain:
It prevents the needful normal glucose level to the body which leads to drowsiness, disorientation and even unconsciousness.
When the secondary supply of fatty acids are stopped to balance the Glucose level in the body amino acids are released which are toxic to brain cells due to which the children may suffer from convulsions, deepening coma and even death.
Can hypoglycaemic encephalopathy be prevented and treated in under-nourished children?
Yes, hypoglycaemic encephalopathy can be prevented and treated in under-nourished children.
Prevention: Since 2015 Dr. T Jacob John’s prevention strategy has helped in reducing the number of deaths in Muzaffarpur due to hypoglycaemic encephalopathy.
Treatment: Full and complete recovery can be achieved if children with hypoglycaemic encephalopathy are infused with 10% dextrose within four hours after the onset of symptoms. Infusing 10% dextrose not only restores blood sugar to a safe level but also stops the production of amino acid that is toxic to brain cells by shutting down the body’s attempt to convert the fatty acid into glucose.
