At least 47 children have died in the north-Indian state of Bihar in the past month – more than 100 are still receiving treatment at two hospitals, meaning the death toll could rise sharply.
The state government is yet to confirm the cause of the outbreak but is attributing most of the deaths to hypoglycaemia – low blood sugar level. ’47 children have died of acute encephalitis syndrome, which involves inflammation of the brain’, said the state government. The disease, an annual recurrence since the past 25 years is being linked to a toxin substance in lychees and triggered when consumed on a hot day by children, most of them who are malnourished.
The deaths are occurring around Muzaffarpur, an area known for its abundant lychee orchards. According to a 2014 study by The Lancet Global Health, “lychee has some kind of toxin that goes and deposits in the liver of these children, and when the temperatures go up, those toxins get released”. The study found that parents reported that children in affected villages spent most of the day eating lychees from nearby orchards, often returning home in the evening “uninterested in eating a meal.” Children who fell ill were twice as likely to have skipped dinner, which, according to the researchers, probably resulted in “night-time hypoglycaemia.” The study said that when the children’s blood sugar level dropped, the body would start to metabolize fatty acids to produce a boost of glucose. However, urine samples found that two-thirds of the ill children showed evidence of exposure to toxins in lychee seeds, found in higher levels in unripe fruits. In the presence of these toxins, “glucose synthesis is severely impaired,” the study said, leading to dangerously low blood sugar and brain inflammation.
According to Sanjay Kumar, a senior state health official, “the affected children are from poor families, and they do not have sugar reserves, and they are also malnourished.” He also added that the heat has been ‘especially intolerable’ this year, and once the monsoons arrive, the temperature drops and such cases automatically drop.
In 2013, 351 people died of similar circumstances, triggering the 2014 Lancet Study.