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Published Date: 2019-06-14 08:07:41
Subject: PRO/AH/EDR> Japanese encephalitis & other - India (04): (BR)
Archive Number: 20190614.6519707
JAPANESE ENCEPHALITIS AND OTHER - INDIA (04): (BIHAR)
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Date: Thu 13 Jun 2019 23:20 IST
Source: Business Standard, Asian News International (ANI) report [edited]
https://www.business-standard.com/article/news-ani/bihar-encephalitis-claims-54-children-132-hospitalised-in-muzaffarpur-119061301374_1.html


As many as 54 children have died over the past few weeks due to the acute encephalitis syndrome (AES) and over 130 have been hospitalised till now in Bihar in Muzaffarpur.

A total of 46 patients died at Sri Krishna Medical College and Hospital (SKMCH) while 8 succumbed at the private Kejriwal Hospital here [Muzaffarpur] on [Thu 13 Jun 2019].

Earlier today, Civil Surgeon Shailesh Kumar Singh said, "47 children have died due to AES and 137 are admitted in hospitals with high fever and other symptoms of the infection. 137 people were admitted in SKMCH hospital out of whom 40 causalities were reported."

Apart from this, Singh said: "41 people were admitted in Kejriwal Hospital where 7 causalities were reported, taking the death toll to 47.

Encephalitis is a viral infection which causes mild flu-like symptoms such as high fever, convulsions, and headaches

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Communicated by:
ProMED-mail
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[The number of acute encephalitis syndrome (AES) cases in Muzaffarpur continues to grow, with as many as 54 AES deaths currently.

The etiology of these cases is not confirmed. In a recent report, the majority of AES cases are reported as hypoglycemic and lychee fruit consumption is implicated. As noted previously, frequently some cases of AES are attributed to Japanese encephalitis but many are of undefined etiology. The determination of the etiology or etiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. AES has continued to be attributed to a variety of etiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES), but existing surveillance for AES does not include routine testing for dengue.

It has been proposed previously that consumption of lychees is responsible for some encephalitis cases. Encephalopathy and hypoglycemia have been associated with consumption of lychee fruit containing phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no.20150201.3132842). However, Dr Jacob John has asserted that many of these are hypoglycemic Reye syndrome cases. He noted that in the pre-monsoon period, particularly in May and June, outbreaks of Reye-like acute hypoglycemic encephalopathy occur in the north western region of Bihar state and that is also popularly, but unfortunately, called AES. Many doctors, the media, and the public consider these encephalopathy cases as encephalitis because of the term AES. This has been now clarified and in June 2014 children were treated by 10 per cent dextrose infusion and many lives were saved. Other etiologies have been proposed by clinicians. A published article in a pediatric journal proposed that some cases are due to heat stroke.

Reference
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Shrivastava A, Kumar A, Thomas JD, et al: Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health. 2017; 5(4): e458-e466. doi: 10.1016/S2214-109X(17)30035-9; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30035-9/fulltext.

Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible. - Mod.TY

Maps of India: http://www.mapsofindia.com/maps/india/india-political-map.htm and http://healthmap.org/promed/p/11360]

See Also

Japanese encephalitis & other - India (03): (BR) 20190612.6515634
Japanese encephalitis & other - India (02): (BR) 20190609.6510811
Japanese encephalitis & other - India (01) 20190112.6255835
2018
----
Japanese encephalitis & other - India (23): (MH) 20181220.6216363
Japanese encephalitis & other - India (22): (MP) 20181112.6141152
Japanese encephalitis & other - India (21): (AS) 20181108.6132872
Japanese encephalitis & other - India (19): (MP) 20180827.5991109
Japanese encephalitis & other - India (18): (BR) 20180823.5981659
Japanese encephalitis & other - India (17): (AS) 20180818.5974190
Japanese encephalitis & other - India (16): (UP) 20180814.5964023
Japanese encephalitis & other - India (15): (AS) 20180812.5961217
Japanese encephalitis & other - India (14): (AS) 20180805.5948662
Japanese encephalitis & other - India (13): (UP) 20180711.5900435
Japanese encephalitis & other - India (12): (AS) 20180701.5883729
Japanese encephalitis & other - India (11): (AS) 20180628.5881510
Japanese encephalitis & other - India (10) 20180620.5866496
Japanese encephalitis & other - India (09): (AS) 20180618.5862346
Japanese encephalitis & other - India (08): (BR) 20180618.5860635
Japanese encephalitis & other - India (07): (MP) 20180614.5855342
Japanese encephalitis & other - India (06): (HP) 20180607.5844658
Japanese encephalitis & other - India (05): (KL) 20180605.5840545
Japanese encephalitis & other - India (04): (KL) 20180530.5827153
Japanese encephalitis & other - India (03): (AS) 20180523.5812921
Japanese encephalitis & other - India (02): (UP), typhus 20180416.5749050
Japanese encephalitis & other - India: (KA, UP) 20180110.55507
2015
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Encephalopathy, hypoglycemia - India: (BR) litchi, methylenecyclopropylglycine 20150201.3132842
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