Why Is The Litchi Toxin Causing Deaths | Burning Issues | PDF Download

Why in NEWS?

• Acute encephalitis syndrome (AES) in few districts of Bihar has so far claimed the lives of many children.
• Low blood sugar level has been attributed for most of the deaths. (hypoglycaemia).

What is AES?

• It is a basket term used for referring to hospital, children with clinical neurological manifestations.
• Meningitis , encephalitis, encephalopathy, cerebral malaria, and scrub typhus are collectively called acute encephalitis syndrome.
• While microbes cause all the other conditions, encephalopathy is biochemical in originThere are differen types of encephalopathy.
• In the present case, it is associated with hypoglycemia and hence called hypoglycemic encephalopathy.

Encephalitis vs hypoglycaemic encephalopathy

• The two conditions show very different symptoms.
• Fever on the first day is one of the symptoms of encephalitis
• In the case of hypoglycaemic encephalopathy, fever is always after the onset of brain dysfunction
• And not all children exhibit fever.
• The blood sugar level is different .

Hypoglycaemic encephalopathy?

• However, in hypoglycaemic encephalopathy, children go to bed without any illness
• The blood sugar level is low, hence the name hypoglycaemic encephalopathy.
• Children died due to hypoglycaemic encephalopathy.
•  According to a PIB release hypoglycaemia (low blood sugar level) was reported in a “high percentage” of children who died.

 Young Children Affected

• It is an observed fact that malnourished children between two to 10 years fall ill
• It is not known why older children not suffered the same way.
• Reason why the underlying cause of the illness cannot be a virus.
• A virus does not discriminate by age
• It has also been documented that most of the children falling ill are from families camping in orchards to harvest the fruits.
• Outbreaks are restricted to April-July, with a peak seen in June. This is because litchi is harvested during this period.

 Litchi

• A research shown that a toxin found in litchi fruit that was responsible for causing hypoglycaemic encephalopathy.
• Toxin called methylene cyclopropyl glycine (MCPG).
• Undernourished children who had gone to sleep without a meal
• The liver is unable to supply the need.
• So the alternate pathway of glucose synthesis, called fatty acid oxidation, is turned on. That pathway is blocked by MCPG.
• Litchi does not cause any harm in wellnourished children, but only in undernourished children.

MCPG

• The toxin acts in two ways
• Because of the toxin, the body’s natural mechanism to correct low blood glucose level is prevented.
• This leads to drowsiness
• Amino acids are released which are toxic to brain cells.
• The amino acids cause brain cells to swell
• Children may suffer from convulsions, deepening coma and even death.
• Undernourished children do not eat plenty of litchi fruit.
• They should eat some food and not go to bed on an empty stomach.

Is there any treatment?

• Yes, hypoglycaemic encephalopathy can be easily treated with infusing dextrose
• 3% saline solution helps in reducing oedema of the brain cells.
• If dextrose infusion is not started within four hours after the onset of symptoms, the brain cells may not recover but will die.
• Even if they survive, children suffer from various aspects of brain damage.

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