PATNA/MUZAFFARPUR: Scores of children are admitted in the government hospital in Muzaffarpur. The symptoms are the same, high fever followed by seizures. Over 105 children almost all of them below 10, have died till now from what is medically known as acute encephalitis syndrome (AES).
The children have perished in the past few weeks in Muzaffarpur from the brain disease, which has also been blamed on toxins found in litchis. Between 2000 and 2010, over 1,000 children in the district succumbed to the infection, which leads to swelling in the head. The cause itself has eluded researchers, but experts say a deadly cocktail of heatwave, malnourishment and binging on litchis on an empty stomach is to be blamed for the high death toll this year. And the cure could have been as simple as timely administration of glucose.
Dr G S Sahni, head of pediatrics at Muzaffarpur-based Sri Krishna Medical College and Hospital (SKMCH), where the majority of the AES cases are admitted, said it would not be prudent to blame litchi alone. “Then urban kids too should have fallen to the disease,” he said. “In the past two decades, there have barely been four AES cases from urban pockets.” Poverty and malnutrition may hold the answer. Most of the children dying from AES belong to the poorest of the poor — the Mahadalit community, including Musahar and scheduled castes — and most of them were malnourished.
Distraught parents lined up at hospitals in Bihar, with the fever now being reported also from neighbouring East Champaran, Sheohar and some parts of Sitamarhi districts. Recently, two blocks of Vaishali witnessed some suspected cases.
What seems to be compounding the problem is acute shortage of doctors, unavailability of key medicines, and lack of nursing staff and beds. State-run health establishments in Muzaffarpur, including SKMCH, all suffer from this. SKMCH superintendent Dr S K Shahi said the facility has not yet been provided any additional funds for the treatment of AES patients.
“Infrastructure is not adequate to deal with the influx of patients,” he said. Union heath minister Dr Harsh Vardhan and state health minister Mangal Pandey, who visited the hospital on Sunday, said a new and separate building for paediatrics with 100 beds would be built soon.
What is AES?
Acute Encephalitis Syndrome (AES) is a disease characterised by high fever that alters consciousness
Mostly affects children below the age of 15
Symptoms include headache, body ache, fever, nausea, vision impairment, hearing loss, paralysis, seizures, unconsciousness
Treatment includes antiviral medication, plenty of fluids, glucose
Affected families, many of them angry and waving black flags at politicians and officials, said they were not getting the support they need. Sunita Devi, mother of 5-year-old Nidhi who died at SKMCH on Saturday, said the hospital is crowded with children who need urgent attention.
But even as the number of patients grew, experts and doctors were unsure what could be at the heart of the disease. According to a study published in The Lancet Global Health medical journal in 2017, children in affected villages had spent most of their days plucking and eating litchis from nearby orchards, often skipping dinner, which led to an alarming drop in their blood sugar.
The connection between litchis and AES
Experts say that the fruit is not to be blamed, but the way it is consumed
Litchis contain Methylene cyclopropyl-glycine (MCPG), which severes the body’s ability to synthesise sugar when blood sugar levels are low
Most of the affected children are malnourished. Consuming the fruit on an empty stomach forces the body to metabolise fatty acids to boost glucose levels. This in turn leads to hypoglycaemia
When sugar levels drop, the body starts to metabolise fatty acids to produce glucose. But in malnourished kids exposed to toxins such as methylene cyclopropylglycine (MCPG) found in litchis, glucose synthesis is impaired, leading to dangerously low blood sugar and brain inflammation. The same study had recommended minimising litchi consumption, ensuring an evening meal and implementing rapid glucose correction for suspected illness.
Muzaffarpur-based senior pediatrician Dr Arun Shah, member of the national executive committee of Indian Paediatrics Association, said. “In case of a sudden fall of glucose – termed as hypoglycaemia — the body uses its glucose reserves. Malnourished children have no such reserve in their body. Thus, those given artificial sugar can be saved. But a delay of even half an hour can be fatal.”
Bihar and UP worst affected; cases have also been reported from Assam, Jharkhand, Manipur, Odisha among others
2018: 10,485 cases detected in 17 states
2018: 632 deaths reported across the country
Fatality rate of 25% among children and an overall fatality rate of 6%
Source: National Vector Borne Disease Control Programme
“Sometimes their households have nothing to eat but litchis are in abundance in the summer. Groups of children can be spotted in litchi orchards all day,” said Jahangir Alam, a resident of Dariapur, where most of the cases in the last five years have been detected.
Malnourished children have no reserve (glucose) in their bodies. Those given artificial sugar can be saved. But a delay of even half an hour can be fatal
Experts have also connected intense heatwave in the country to the disease, although what role it plays is not clear. “Excessive heat definitely has a part to play in the outbreak of AES and higher number of casualties this year. The temperature has been much higher than in the past couple of years,” Muzaffarpur civil surgeon SP Singh told TOI. In 2017 and 2018, when the summers were not as harsh, the death toll from encephalitis was 11 and seven respectively.