Children would wake up in the middle of the night with a scream, suffer convulsions and go into coma.

Love litchis Toxins in the fruit to blame for thousands of child deaths in BiharImage for representation
news Medicine Thursday, February 02, 2017 - 13:18

Every year, an epidemic hits Muzaffarpur, Bihar around mid-May where children suffer sudden convulsions, go into coma and eventually die. Explanation for this ghastly illness had been evading experts until recently, when researchers found that the trigger could be a toxin found in litchis.

As per a study published in The Lancet, researchers conducted tests on children under 15 years of age admitted to two hospitals in 2014 with the symptoms matching those mentioned earlier. The condition is called “acute encephalopathy” and out of 390 children who were admitted, 122 (31%) had died.

“Litchi consumption and absence of an evening meal in the 24 hours preceding illness onset were associated with illness,” says the study, undertaken by Indian epidemiologists under the Indian and US Centers for Disease Control and Prevention (CDC). This essentially means that the children consumed the litchi fruit on an empty stomach. They were also found to be malnourished.  

The illness was accompanied by dangerously low glucose levels. “We believe it’s likely to be some sort of toxin that causes a sharp drop in blood sugar levels that then leads to seizures,” Dr Padmini Srikantiah, one of the authors of the study told  Gardiner Harris for New York Times.

Litchi is grown in abundance in Muzaffarpur and contributes to 70% of India’s litchi production. The illness strikes children just as the fruit ripens each year, peaking in June and vanishing suddenly in July as the monsoon arrives. This led researchers to test for a toxin found in litchi seeds.

Parents of the children narrate that otherwise healthy children awake with a scream in the night or early morning and suffer convulsions before losing consciousness. Doctors report that their attempts to keep the children hydrated bear little result, as most of them succumb within hours.

Reports of the earliest such cases date back to 1995. Ellen Barry reports for New York Times that these cases were ascribed to heat stroke, infections carried by bats and rats, and even pesticides. But none of these bore evidence. Similar outbreaks are known to occur in Bangladesh and Vietnam’s litchi-growing regions as well. Mortality rates are generally high.

Dr Rajesh Yadav who works with CDC in Atlanta, told the New York Times, “It was a very intense situation, because we witnessed children dying in front of our eyes every day, as soon as they arrived at the hospital.”

The study recommends that to prevent the illness and improve chances of survival, litchi consumption needs to be minimized and an evening meal should be ensured. If the illness is suspected, glucose should be administered quickly to the patient if found to be low.

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