'Chamki Ki Bimari’ – Mystery Behind The Children’s Death in Bihar: Toxins in Litchi

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Highlights

  • In 2014, more than 100 children in Muzaffarpur, Bihar died after eating litchis but the reason was unknown.
  • Litchi contains toxins which may inhibits the body’s ability to synthesize glucose, leading to low blood glucose levels.
  • Scientists from the U.S. and India have found that consumption of litchi fruit and skipping evening meal can result in very low blood glucose level and acute encephalopathy, seizures and coma, and causes death in many cases.

Nature is man’s best friend but we have to be careful in how we treat our best friend.

Every year over the last two decades, large numbers of young children have been dying in Bihar’s Muzaffarpur of a mysterious brain disease. They would run high fever, have seizures and slip in and out of consciousness.

People in Bihar call it ‘chamki ki bimari’.

Heat, humidity, malnourishment, the monsoon and pesticides have contributed to the illness in the children.

Eating litchi fruit may be behind the mysterious brain disease that has caused hundreds of unexplained deaths among children in recent years in Bihar, a new study published in the Lancet Global Health journal has claimed.

Outbreaks of an acute neurological illness with high mortality among children occur annually in Bihar’s Muzaffarpur, the country’s largest litchi cultivation region.

‘Hypoglycin A and methylenecyclopropylglycine which are naturally present in litchi fruit block enzymes involved in normal glucose metabolism and this results in an inability to synthesis glucose leading to acutely low level of blood sugar.’

Most of the victims were poor children in India’s main lychee-producing region who ate fruit that had fallen on to the ground in orchards, the journal said.

“We aimed to investigate the cause and risk factors for this illness,” researchers said.

In a hospital-based surveillance, researchers from the National Centre for Disease Control in New Delhi and the US Centres for Disease Control and Prevention undertook laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness.

Children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur in 2014 with new-onset seizures or altered sensorium were included in the study.

They were age-matched against residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. This group served as the control.

Specimens of blood, cerebrospinal fluid and urine as well as litchis were tested for evidence of infectious pathogens, pesticides, toxic metals.

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Scientists also looked for other non-infectious causes, like presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement.

Between May 26 and July 17 in 2014, 390 patients meeting the case definition were admitted to the two hospitals in Muzaffarpur, of whom 122 (31 per cent) died, researchers said.

On admission, 204 (62 per cent) of 327 had blood glucose concentration of 70 miligrammes per decilitre or less. 104 cases were compared with 104 age-matched hospital controls.

Litchi consumption and absence of an evening meal in the 24 hours preceding illness onset were associated with illness.

The absence of an evening meal significantly increased the effect of eating litchis on illness. Tests for infectious agents and pesticides were negative.

Metabolites of hypoglycin A, MCPG, or both were detected in 48 (66 per cent) of 73 urine specimens from case-patients and none from 15 controls.

“Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity,” the researchers said.

“To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness,” advised the researchers.

If a child falls ill, the researchers said they should be treated quickly to correct their glucose levels to prevent lasting damage such as mental impairment, muscle weakness and movement disorders.

Mysterious deaths in Bihar’s Muzaffarpur 

Bihar’s Muzaffarpur- India’s largest litchi cultivation region – has been plagued with a mysterious epidemic. From 1994 to 2014, almost 1,000 children in the area have died of a strange disorder, India Today reported in 2014. For many years, doctors were confused about the exact cause of the seasonal outbreak of the illness that causes those afflicted with it to have seizures and lose normal brain functioning before ultimately dying, The Times of India reports.

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