Dozens of parents are protesting outside hospitals as the deaths of over 100 children have been linked to a deadly brain disease. Concerned citizens across the Indian state of Bihar are up in arms after health authorities confirmed last week that at least 150 children have died after contracting acute encephalitis. While the exact cause of the outbreak is unknown, experts believe it to be either the work of a virus or environmental toxins connected to lychees.
The prevalence of the disease, which causes a potentially fatal inflammation of the brain, remains a mystery to many. According to Sanjay Kumar, an official from the Indian health department, "international experts have told us that lychee has some kind of toxin that goes and deposits in the liver of these children ... the fact is that [this] is a lychee-growing area. We suspect that there is some kind of role that lychee has in the case. But it is also true that once the temperature comes down and the rains come, lychee or no lychee, there are no more cases." This confusion has left authorities hamstrung as to how to best approach the problem.
The cases of acute encephalitis appear particularly concentrated in and around the city of Muzaffarpur - a community of nearly five million people that has historically been a base for lychee production. In fact, the countryside around the city accounts for approximately 70 per cent the nation's entire industry, making it a natural stronghold for a lychee-related illness. According to a report by CNN, “in 2014, nearly 117 deaths were reported in Muzaffarpur,” though that number has dipped in recent years. Sanjay Kumar has also reluctantly confirmed that, "this year, the number [of cases] has gone up a bit."
Though the ongoing disaster is undoubtedly tragic, this is not the first time that the mysterious disease has ravaged the region. According to a paper published in the Indian Journal of Medical Research in 2017, "between 2008 and 2014, there have been more than 44,000 cases and nearly 6000 deaths from encephalitis in India, particularly in Uttar Pradesh and Bihar". These are both areas where lychee production and consumption is commonplace. As part of the official government response, Kumar has suggested that the affected children are from “poor families, and they do not have sugar reserves, and they are also malnourished,” adding that, "the liver stores glycogen. When the sugar level goes down, the liver releases extra sugar to balance it out, but if there is no extra sugar and there are only toxins, then they get released."
The 2017 paper, coupled with American research published in the Lancet medical journal, prompted authorities to take action. They began to warn families of the risks associated with allowing children to eat lychees if they haven't eaten anything else, which in turn caused parents to change their behaviour. A New York Times reporter confirmed this in an interview with local resident Kamini Kumari, who revealed that, "(we) all eat lychee around here, but we don’t let the children do it on an empty stomach.” However, despite the caution of local communities, cases in 2019 have skyrocketed, suggesting that there may well be other factors at play.
One of the theories that is beginning to gain traction is that the fatalities, which disproportionately affect children under the age of five, are linked to a heat wave that's currently crippling the area. Sanjay Kumar revealed that the same "international experts" who concluded that dormant toxins are being released by the liver have also suggested that "when the temperatures go up, those toxins get released". This is supported by a body of evidence that points to the fact that as temperatures rise, the number of cases of encephalitis increases. For several weeks, the temperature in Bihar has been hovering at around 100 degrees Fahrenheit.
Though the association with excessive heat is a compelling diagnosis, medical experts have been keen to draw attention to another significant factor. There is strong evidence to suggest that, as well as potentially increasing the effects of lychee toxins, skipping meals and lowering blood sugar can cause children to enter a state of hypoglycaemia - which can itself cause symptoms of fatigue, blurred vision and loss of consciousness. As CNN have reported, "Bihar health authorities have confirmed that all children displayed signs of hypoglycemia...before they died". This has led some to suggest that it is this widespread potential for hypoglycaemia that has turned a powder keg in Muzaffarpur into a full-blown wildfire.
The complexity of the tragedy means that the science is still relatively murky. As one 2012 paper put it, "the association between litchis (or lychees) and acute encephalitis remains unclear. As with other emerging viruses, we face a multifactorial problem that seems to have litchi (or lychee) fruit production and harvest as its focal point." This view is mirrored by contemporary experts such as Dr. Neelu Desai, who stated that, "if it is [a] virus or a toxin in something they are eating, we don't really know". All this means that the future remains uncertain for an area that relies extensively on a potentially dangerous food source. Only, time will tell whether anything can be done to curtail future outbreaks.