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Published Date: 2017-07-28 19:42:41
Subject: PRO/EDR> Undiagnosed deaths - Bangladesh: (RP), pesticide identified, 2012
Archive Number: 20170728.5212796
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 27 Jul 2017
Source: Scroll In [edited]

A medical investigation into the deaths of 13 children in Bangladesh in 2012 has now revealed that they were most probably caused by insecticides and not by litchi seeds.

The children, who were from a rural community in the Dinajpur District in northern Bangladesh, had all experienced acute encephalitis syndrome or AES - a condition associated with fatal inflammation of the brain. Fourteen children became ill between 31 May and 30 June 2012 and only one survived. All the deaths occurred within 20 hours of the onset of symptoms and were linked to exposure to the litchi fruit, which is cultivated across South Asia.

Similar deaths were recorded in Muzaffarpur, a district in Bihar, India. Analyses of those cases indicated that toxic compounds in the litchi fruit trigger low blood glucose levels in malnourished children who skipped evening meals leading to death.

However, a team of researchers from the International Centre for Diarrhoeal Disease Research and the Institute of Epidemiology Disease Control and Research in Bangladesh, and from the Centers for Disease Control and Prevention and Center for Innovation in Global Health in the United States have looked into the Bangladesh litchi deaths and found that the AES was probably triggered by excessive and improper applications of insecticides and other agriculture chemicals in local fruit orchards.

The researchers pointed out that the litchi seeds were not eaten and if the seeds were the cause, then there would have been cases scattered across the country and not just in a certain small area.

The scientists discovered that the 2012 outbreak occurred during harvest time and growers were applying endosulfan in the orchards, a highly toxic insecticide that has been banned in more than 80 countries. In 2016, Bangladesh was one of several countries, including India and the United States, that still allowed restricted use of endosulfan.

Local residents told the investigators it was common for children to play in the orchards and to eat fruit that had fallen on the ground without washing it, using their teeth to peel the tough skin. Moreover, several of the victims had family members who worked in the orchards and this could have increased exposures to insecticides through residues on clothing worn into the home.

The research team collected physical evidence from the orchards, which included discarded containers of insecticides and other chemicals. They interviewed residents to find multiple chemicals were applied to the fruit and in amounts far greater than are normally used by other lychee producers. The study also found evidence that the lychee growers were applying an insecticide that had been approved only for use in cotton, not food crops.

The findings were published in the American Journal of Tropical Medicine and Hygiene. The scientists plan to conduct follow-up studies to get more biological evidence liver and brain biopsies of the victims.

Communicated by:

[ProMED-mail posted the original article regarding this situation in 2012 as Undiagnosed deaths - Bangladesh: (RP), pesticide susp., RFI Archive Number:20120629.1184443. The original article specified that pesticides were a possibility, and not the fruit. However, the pesticide was not identified at the time of the original article. We would like to point out this article is directly related to the 2012 incident, so this situation is apparently not occurring now, or has not been reported again since that time.

Endosulfan, a commercial product of 2 isomers, is a chlorinated hydrocarbon insecticide. As such, it may be used as wood preservative, but is also a contact poison for many insects and mites. Therefore it has been used on food crops, such as vegetables, grains, fruits and teas to rid these crops of damaging pests.

Endosulfan is a highly toxic substance whose toxicity is partly dependent upon how the pesticide is applied. The body absorption is rapid in the presence of alcohols, oils or other emulsifiers (on the skin or in the preparation), but otherwise is slowly and incompletely absorbed by the body.

Generally endoslfan appears to affect the central nervous system. Acute symptoms include incoordination, agitation, convulstion and even loss of consciousness. Other symptoms include vomiting, and diarrhea. In cattle grazing fields sprayed with endosulfan blindness has been documented. Furthermore, these animals may recover when removed from the exposure and given time, perhaps of a month or more. Likewise sheep and pigs grazing on treated fields have been reported with incoordination and blindness

Chronic toxicities may affect kidneys, liver, blood chemistry and the parathyroid gland. There may be other chronic effects such as reproductive effects, teratogenic, mutagentic and or carcinogenic effects.

While endosulfans can and do affect a number of body systems chronically, the case of the children in the fruit orchards is an acute case.

It seems that despite the age of the original case, we at least have an answer regarding the poisoning of the children. - Mod.TG

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/35161.]

See Also

Undiagnosed deaths - Bangladesh: (RP), pesticide susp., RFI 20120629.1184443.

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