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Poverty, not virus, behind Muzaffarpur syndrome
Acute Encephalitis Syndrome (AES) kills hundreds of children in Muzaffarpur and other places in Bihar and UP every year during April-July. Viruses like Japanese Encephalitis Virus (JEV), Nipah virus and enteroviruses were blamed for the AES. It has recently been discovered that the AES is caused by a litchi toxin, Methylene Cyclopropyl Glycine. During the litchi harvest season, the poverty-stricken workers camp in the orchards and their malnourished children eat a lot of the fruit that fall to the ground. Litchi in empty stomach aggravates hypoglycaemia in the poor children and death results from brain damage called AES.

PATNA, Sept 7: Acute Encephalitis Syndrome (AES) has been claiming hundreds of lives in Bihar and UP for decades. It is reported that about 10,000 people have lost their lives in the last 15 years.

It has been an annual seasonal occurrence in Bihar's Muzaffarpur and other districts as also in UP's Gorakhpur. Japanese Encephalitis Virus has been suspected to be causing the syndrome for long. Several other theories were also doing the rounds like bat virus, heat stroke, pesticide exposure etc.

Acute Encephalitis Syndrome (AES) is an umbrella term for conditions associated with inflammation of the brain caused by agents like virus, bacteria, chemicals etc. Major viruses are Japanese Encephalitis Virus (JEV) and Nipah virus and enteroviruses. Most common is JEV. The symptoms of AES are fever, headache, seizures, coma. AES can also be caused by certain chemicals and toxins.

It has been found that most of the children falling ill are from labour class families camping in orchards to harvest litchi and that they are the poorest of the poor. These children eat the fruits that fall on the ground. So April-July was found to be the peak season when children develop the syndrome. Litchi is harvested during this period.

Recently it was discovered that a toxin in litchi aggravates hypoglycaemia in poor children and death results. Hypoglycaemic encephalopathy can be easily treated with dextrose with saline to reduce odema if treated in four hours. A direct relation between AES and litchi has been established in recent times.

There are two litchi toxins called Methylene Cyclopropyl Glycine (MCPG) and Methylene Cyclopropyl Acetic Acid. As the children are malnourished, there is depletion of glucogen reserves in the liver and the need arises for gluconeogenesis. Gluconeogenesis synthesises glucose from non-glucose sources like proteins and fats to maintain blood sugar level. The toxins stop gluconeogenesis resulting in hypoglycemia and then aminoacidemia results in brain damage called AES. The malnourished children eat a lot of the fruits in empty stomach.

"When the human condition was simulated in animals, there was deprivation in body weight and glucose levels in starved litchi seed dosed rats, causing hypoglycemia. These results suggest that the cause of hypoglycemic encephalopathy in Muzaffarpur is related to the consumption of semi ripe and ripe litchi fruits by undernourished children," an NIH, USA, study said.

Vietnam, Thiland, China, Nepal also experience the outbreak in litchi season.

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