What is Encephalitis, Syndrome, Treatment: Acute encephalitis syndrome (AES) has claimed over 130 lives in the past one month in Bihar with children being the main victim. The Syndrome is considered a very complex disease.
Encephalitis Symptom, Diagnosis Treatment: As the death toll is rising every day in Bihar, Acute encephalitis syndrome has become a serious issue for the government. As per reports over 130 individuals have lost their lives to the AES outbreak. The main victim of Acute Encephalitis Syndrome (AES) are children and young adults whose central nervous system are affected. The starting symptoms include high fever which then develops by hampering neurological functions leading to mental disorientation, seizure, confusion, delirium, and coma.
According to the National Centre for Disease Control officials, Acute Encephalitis Syndrome (AES) outbreaks in Muzaffarpur have been reported since 1995. This year the main cause of death in most cases has been attributed to hypoglycemia (low blood sugar level). How is hypoglycemia related to these deaths and what are researchers suggesting? Usually, the disease strikes during monsoon (June-October) but Bihar reportedly showed a high number of affected people during April-June this year.
Acute Encephalitis Syndrome (AES) is considered a very complex disease as it can be caused by various agents including bacteria, fungi, virus and many other agents. In most of the cases reported in India, Japanese Encephalitis (JE) virus is considered the most common cause according to an estimate by Union Health Ministry. As much as 5 per cent to 35 per cent cases reported involve Japanese Encephalitis (JE) virus. The most worrying fact is that the syndrome can also be caused by agents like dengue, mumps, measles, even Nipah or Zika virus. In several cases, the cause of AES remains clinically unidentified.
In India, the numbers of people infected last year mount to as much as 10,485 cases of AES with 632 deaths across 17 states according to the National Vector Borne Diseases Control Programme (NVBDCP). The fatality rate due to Acute Encephalitis Syndrome (AES) is as high as 6 per cent in India, but it rises to 25 per cent amongst children. The state of Bihar, Assam, Jharkhand, Uttar Pradesh, Manipur, Meghalaya, Tamil Nadu, Karnataka, and Tripura are worst affected.
According to Bihar government officials, AES is not a disease but a syndrome and the main cause of death among children due to AES was prolonged hypoglycemia with delayed treatment. A 2014 research study on ‘Epidemiology of Acute Encephalitis Syndrome in India: Changing Paradigm and Implication for Control’ co-authored by six researchers compared Muzaffarpur and Vietnam’s Bac Giang province as both the places had similar condition and undernourished children were suffering from AES and hypoglycemia at the same time with presence of Litchi Orchards in neighbourhood. According to the research, “The findings of the possible association with some toxin in Litchi or in the environment is required. Methylene cyclopropyl glycine (MCPG), a toxin present in litchi fruit has been shown to cause hypoglycemia in experimental animals,” it stated. The researchers also found that there has been a history of visit to litchi orchards among children of Muzaffarpur who suffered from AES before 2014. Undernourished children who remain hungry for several hours face much worse impact.
State Surveillance Officer of Bihar, Dr. Ragini Mishra contradicts the research theory by questioning the number of infected people over the years. She says that if the Litchi toxins are the main cause then the AES cases should remain consistent in this region every year (Muzaffarpur being a mega producer of Litchi in India) and should affect the children of all socio-economic strata. This year most numbers of deaths have been recorded among the economically backward individuals/children. In a statement to The Indian Express, she said that “We had very few cases last year and the mortality was less. Also, the heatwave is at its peak in this part of the country there must be some correlation between high temperature and AES. Last year hot days were followed by rain showers. This year, the heat has been prolonged with no sign of rain.
Infectious diseases expert Dr. Om Srivastava says “Associating Litchi to the AES deaths due to the presence of the infectious organism in it is well documented, but it cannot be attributed only to this factor as the main cause of death. AES involves multiple factors,” he told The Indian Express. He further added that “until hypoglycemia is prolonged and cannot be corrected it in itself is not a sufficient reason to explain deaths. “There are other contributing factors that increase the risk of death, undernutrition is just one.”
On the other hand, former Bihar president of Indian Academy of Paediatrics Association, Dr Arun Shah said that “Dr. Jacob John’s who is a member of Centre for Disease Control, Atlanta team and virologist at CMC Vellore’s findings in the past have narrowed down to malnutrition, heat, humidity and poor hygiene as reasons of AES”. Dr. Shah further told The Indian Express that AES onset is reported mostly in mornings, especially when a child goes without food the previous night and the sugar level in blood dips further. A malnourished child has no buffer stock of sugar in the liver. He also claims that litchi has nothing to with AES. It might be a factor among malnourished children who ate unripe or rotten litchi leading to more severe AES due to the presence of toxins (MCPG) in Litchi.