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No link between litchi, AES, say experts

AES outbreak in Siliguri in 1996, traced to imported raspberry, may have led to ‘litchi theory’.

Written by Pritha Chatterjee | New Delhi | Updated: June 12, 2014 8:18 am

Experts looking into the annual outbreak of a disease in parts of Gorakhpur in Uttar Pradesh and Muzaffarpur in Bihar, which has claimed the lives of many children, have told The Indian Express that it has nothing to do with the cultivation of litchi. The disease, for the first time, has also led to the deaths of children in Malda district of West Bengal this year.

In the absence of any known pathogen or infectious agent, the symptoms are described as acute encephalitis syndrome (AES). Since those affected reside close to litchi plantations, it has been loosely described as “litchi syndrome” as well. Some experts feel that the children are affected by colouring agents and insecticides used on the fruit crop. However, no connection has been established.

Meanwhile, West Bengal’s Minister of State for Health Chandrima Bhattacharya said Wednesday that children should not eat green litchi. “It contains toxins, which reduces the blood sugar level as well as glucose in the body leading to the infection, particularly in children,” she was quoted as saying in the Assembly.

Dr Vishal Nath, the director of Muzaffarpur-based National Centre for Litchi under the Indian Council of Agricultural Research (ICAR), said, “We have been working on investigating a correlation between litchi and the AES cases for years, and have performed hundreds of toxicology studies. Last year, we had a team of experts from the Centre for Disease Control in the US, and the National Centre for Disease Control in Delhi. Even this year we have doctors from the field conducting tests everyday…we have established zero association between the two. It is ridiculous to still call the disease a litchi syndrome or associate it with the fruit in anyway.”

Nath pointed out that while the crop begins to bear fruit in the first week of May, the AES cases start surfacing a month later in June, when 90 per cent of the crop has been “picked, sold and disposed of”.

“Our research teams have also busted the theory that children who contract the disease may have eaten the fruit fallen from trees, which may have been touched by rats or bats. Zoologists and toxicologists from multiple agencies have conducted tests and found no toxins in the bodies of diagnosed children or on fruit samples,” Nath explained.

Experts say a history of a similar “AES” outbreak in Siliguri in 1996, which was traced to imported raspberry, might be behind this litchi theory.

Experts at the ICMR’s Rajendra Memorial Research Institute (RMRI), Patna, who have been trying to identify a cause for the outbreaks in Muzaffarpur, said no known cause of the disease was identified yet. “We do not know if there is a pathogen or any environmental factors or infectious agents behind the disease. AES is a term for a broad spectrum of diseases which have encephalitis-like syndrome, including fever convulsions and high mortality, but we do not know what the disease is exactly,” Dr Pradip Das, director of RMRI, said

In-charge of National Centre for Disease Control, Patna, Dr Ram Singh said tests performed by their scientists and CDC in the US last year had “shown no association with litchi, or helped us identify any cause of the disease”.

Gorakhpur witnesses JE and AES cases associated with water-borne factors every year. Due to similarities in symptoms, children in Muzaffarpur were first tested for JE. Dr G K Thakur, Medical Superintendent of the Sri Krishna Medical College in Muzaffarpur, one of the two hospitals where children are treated, said all diagnosed cases have tested negative for JE.

“If you take the history of the patients, not all have eaten the fruit. Children less than a year old cannot walk around and eat fruits lying around trees. We treat children with anti-convulsant and fever-controlling drugs,” Thakur said.

Doctors of SKMC published an article in July in the Annals of Tropical Medicine and Public Health saying that high temperatures and humidity could be leading to heat strokes, which may be contributing to the AES like symptoms.

JE immunisation drive in UP, Bihar on June 22-23

The experts’ views came a day after Union Health Minister Dr Harsh Vardhan called an emergency meeting Tuesday on AES. The ministry announced a JE immunisation campaign on June 22-23 in UP and Bihar as a precautionary measure. Harsh Vardhan said there was a need to conduct more research on the still unexplained nature of the disease and set up a a National Virology Centre in Muzaffarpur.

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