• Ajeet Kumar

An Outbreaks of Acute Encephalitis Syndrome (AES) occurred in Muzaffarpur district in the litchi Cultivation season. In Bihar, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur. Cases were investigated on children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur. Age-matched control were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylene cyclo propyl glycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycemia and metabolic derangement. Findings Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9.6 [95% Cl 3.6 – 24]) and absence of an evening meal (2.2[1. 2-4 .3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7.8 [95% Cl 3.3-18.8], without evening meal; OR 3.6[1.1-11.1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 control; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12.4µg/g. To prevent illness and reduce mortality in the region, we recommended minimizing litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected underscoring the importance of using systematic methods in other unexplained illness outbreaks.

Outbreaks, Infectious, Pesticides, Toxic, Pathogens etc.

"Study of Acute Encephalitis Syndrome (AES) in relation with litchi fruit in Muzaffarpur, Bihar (India)", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.5, Issue 1, page no.1251-1257, January-2018, Available :http://www.jetir.org/papers/JETIR1801234.pdf

"Study of Acute Encephalitis Syndrome (AES) in relation with litchi fruit in Muzaffarpur, Bihar (India)", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.5, Issue 1, page no. pp1251-1257, January-2018, Available at : http://www.jetir.org/papers/JETIR1801234.pdf