The litchi fruit has been revealed as the culprit behind the mysterious disease, annually claiming lives of children in Muzaffarpur, Bihar.

Outbreaks of a neurological illness with high mortality have been reported in Muzaffarpur since 1995. Muzaffarpur is the India’s largest litchi cultivation area.

The disease appeared every year in mid –May and recorded the highest number of cases in June. Incidentally, this is the season when the fruits are harvested. The children showed signs of acute seizures and changed mental status.

The report shows that most of the children affected by the illness came from poor socio-economic backgrounds. Although many causes had been proposed, including infectious encephalitis and pesticide exposure, none of these was confirmed.

The National Centre for Disease Control in India and the Center for Disease Control and Prevention in the US initiated the joint investigation in 2013. The team set to find out the features, risks, and causes of the illness.

According to the report, out of the 390 children admitted, 122 (31%) had died, and 204 (62%) had shown low blood glucose levels on admission.

Researchers noted that in most cases of the illness, the patient had consumed litchi on an empty stomach, skipping their evening meal 24 hours before the onset of the illness.

The findings, published in the journal Lancet Global Health confirm the link between the disease and litchi consumption.

The researchers explained that blood sugar levels
dropped when the children skipped their meal. The body would then oxidize fatty acids to produce glucose. Hypoglycin A and methylenecyclopropylglycine (MPCG) are toxins naturally found in litchis. These interfere with the metabolism, resulting in low blood sugar. This condition affects the brain causing seizures.

“The investigation confirms that this recurring outbreak of acute encephalopathy is associated with both hypoglycin A and MCPG toxicity from litchi consumption.  This illness is also associated with the absence of an evening meal,” reported the researchers.

“To prevent illness we recommended minimizing litchi consumption among children, ensuring children in the area receive an evening meal throughout the outbreak season,  and implementing rapid glucose correction for suspected illness,” they wrote.

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