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Lychees linked to 31 deaths in Bihar

At least 31 child deaths have been reported from two hospitals in Bihar state’s Muzaffarpur district. The deaths of the children underline a tragic reality for the Muzaffarpur district: this event happens every year.

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Are lychees responsible for a public health emergency?

Media initially attributed the deaths to acute encephalitis syndrome (AES) — the rapid onset of swelling within the brain. This has since been disputed as other reports coming from officials have stated the majority of the children died from hypoglycemia.

At least forty other children are in intensive care units displaying the same symptoms. “We are trying our best to save them,” said S P Singh, the chief medical officer of Sri Krishna Medical College and Hospital.

While reports are now conflicting regarding the means by which the children died, the source is likely to still be the same — lychees.

Illness related to lychee consumption was first mentioned in the media in July 2013 yet has been documented as far back as 1995. Doctors in Muzaffarpur have on a yearly basis struggled to accommodate numerous instances of the disease, affecting only children. In a third of cases, the condition proves lethal only a few hours after onset.

In 2015, researchers in the US attributed the condition to a toxic substance found in lychees. Specifically, it was found that high levels of hypoglycin A and Methylenecyclopropylglycine (MCPG) were present, particularly in the seeds and arils of unripened lychee fruit. Both of these molecules are documented to have a degree of toxicity.

An excess of hypoglycin A is also present in the ackee fruit, known to cause toxic hypoglycemic syndrome, or Jamaican vomiting sickness. The symptoms of this are very similar to that found in the toxicity following lychee consumption, including seizures, coma and death. High levels of hypoglycin A have been shown to cause hypoglycemia as well as inhibit the oxidation of long chain fatty acids.

These toxins are only dangerous at high concentrations. The disease is found exclusively in children — in particular, malnourished children. It is likely that since the illness occurs during the season in which lychees are ripening these, children may be eating large quantities of unripened lychees to compensate for the lack of available food, leading to a build-up of the lethal toxins.

Muzaffarpur is famous for its harvests of lychees. Naturally, these lychees form a staple part of the local diet during the seasons where the fruits are available. Studies have been conducted on the lychees in the past, though the focus of the studies were never the lychees themselves. Rather, they centred on the pesticides or pests associated with the lychee orchards.

Lychees fell under suspicion when it was realised that the incidence of the illness coincided with the lychee season year after year. Locally the condition is referred to as Chamki Bukhar and, in a single outbreak in 2014, claimed as many as 150 lives.

As a recurring issue that rears its head on a yearly basis — claiming the lives of numerous children each time — it is clear more must be done to address the issue. Assessing the situation regarding childhood malnourishment may be a clear avenue by which to reduce deaths associated with the condition.

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