Don't blame the litchi -T Jacob John

-The Indian Express

Deaths in Muzaffarpur are due to chronic malnutrition

Muzaffarpur in Bihar is famous for litchis and infamous for children dying due to annual seasonal brain disease outbreaks. The common brain diseases in children with high mortality are meningitis, encephalitis and encephalopathy. These three have clear-cut differences and very different treatments. Trained paediatricians know how to distinguish the three. If diagnostic criteria are not applied for various reasons, then the three are not distinguished by doctors. That is when an easy diagnostic term covering all three — “acute encephalitis syndrome” (AES) — becomes handy.

Meningitis is most unlikely in large annual seasonal outbreaks. Encephalitis outbreaks in various parts of India are caused by the Japanese Encephalitis (JE) virus, transmitted by Culex mosquitos. The pre-monsoon months of April-May-June have low mosquito density so JE can also be readily excluded. JE occurs in other districts in Bihar, but not in Muzaffarpur, as the ecology is not conducive for Culex breeding.

The disease description that one, only under-nourished children are affected; two, only children between two and 10 years are affected and three, the onset of convulsions and unconsciousness is always between 4 am and 7 am are clear pointers against any virus infection causing the disease. Viruses, including JE, do not respect nutritional status, age and diurnal rhythm.

This inevitably leads us to conclude that the outbreak disease is encephalopathy. The early morning onset and frequent finding of low blood glucose level (hypoglycaemia) point to a biochemical disease related to glucose metabolism. Several hours after food intake (early morning) is when the body tends to develop hypoglycaemia.

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The Indian Express, 3 July, 2019,

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