Announcement

Collapse
No announcement yet.

India: Lychee fruit suspected in mystery illness

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • India: Lychee fruit suspected in mystery illness

    Source: http://www.sbs.com.au/news/article/2...ystery-illness


    Lychee fruit suspected in mystery illness
    A toxin found in lychee fruit has been linked to a mystery illness in India, which has resulted in the deaths of about a third of patients.
    Source: AAP
    30 Jan 2015 - 10:07 AM UPDATED 19 MINS AGO


    A mysterious and sometimes fatal brain disease that has afflicted children in northeastern India for years could be linked to a toxic substance in lychee fruits, US researchers say.

    Investigators say more research is needed to uncover the cause of the illness, which leads to seizures, altered mental state and death in more than a third of cases.

    In the meantime, doctors who encounter sick children should takes steps to rapidly correct low blood sugar, which can make the disease more likely to be fatal, said the report by the US Centres for Disease Control and Prevention.

    The outbreaks have coincided with the month-long lychee harvesting season in and around the Muzaffarpur district of Bihar state since 1995, said the CDC's Morbidity and Mortality Weekly Report...

  • #2
    Source: https://www.nytimes.com/2017/01/31/w...-outbreak.html

    Dangerous Fruit: Mystery of Deadly Outbreaks in India Is Solved
    By ELLEN BARRYJAN. 31, 2017

    NEW DELHI ? Three years ago, Dr. Rajesh Yadav, an investigator with the India Epidemic Intelligence Service, moved to the city of Muzaffarpur, the site of one of the country?s most mysterious outbreaks. And he waited.

    Every year in mid-May, as temperatures reached scorching heights, parents took children who had been healthy the night before to the hospital. The children awakened with a high-pitch cry in the early morning, many parents said.

    Then the youths began having seizures and slipping into comas. In about 40 percent of cases, they died.

    Every year in July, with the arrival of monsoon rains, the outbreak ended as suddenly as it began.

    Beginning in 1995, investigations variously ascribed the phenomenon to heat stroke; to infections carried by rats, bats or sand flies; or to pesticides used in the region?s ubiquitous lychee orchards. But there were few signposts for investigators.

    Instead of occurring in clusters, the illness typically struck only one child in a village, often leaving even siblings unaffected.

    A joint investigation by India?s National Center for Disease Control and the India office of the Centers for Disease Control and Prevention in Atlanta, published in the British medical journal The Lancet Global Health on Tuesday, has identified a surprising culprit: the lychee fruit itself, when eaten on an empty stomach by malnourished children.

    In 2015, as a result of the investigation, health officials began urging parents in the area to be sure to feed young children an evening meal and to limit their consumption of lychees (sometimes spelled litchi). In two seasons, the number of reported cases per year dropped to less than 50 from hundreds...

    Comment


    • #3
      Now to see if they can find a cause in Uttar Pradesh... Ro

      Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study

      Aakash Shrivastava, PhD, Anil Kumar, MD, Jerry D Thomas, MD, Kayla F Laserson, ScD, Gyan Bhushan, MD, Melissa D Carter, PhD, Mala Chhabra, MD, Veena Mittal, MD, Shashi Khare, MD, James J Sejvar, MD, Mayank Dwivedi, MD, Samantha L Isenberg, PhD, Rudolph Johnson, PhD, James L Pirkle, MD, Jon D Sharer, PhD, Patricia L Hall, PhD, Rajesh Yadav, MBBS, Anoop Velayudhan, MBBS, Mohan Papanna, MD, Pankaj Singh, D Somashekar, MD, Arghya Pradhan, MBBS, Kapil Goel, MD, Rajesh Pandey, MBBS, Mohan Kumar, MBBS, Satish Kumar, MD, Amit Chakrabarti, MD, P Sivaperumal, PhD, A Ramesh Kumar, PhD, Joshua G Schier, MD, Arthur Chang, MD, Leigh Ann Graham, PhD, Thomas P Mathews, PhD, Darryl Johnson, PhD, Liza Valentin, PhD, Kathleen L Caldwell, PhD, Jeffery M Jarrett, MS, Leslie A Harden, MS, Gary R Takeoka, PhD, Suxiang Tong, PhD, Krista Queen, PhD, Clinton Paden, PhD, Anne Whitney, PhD, Dana L Haberling, MSPH, Ram Singh, PhD, Ravi Shankar Singh, MD, Kenneth C Earhart, MD, A C Dhariwal, MD, L S Chauhan, DPH, S Venkatesh, MD, Dr Padmini Srikantiah, MD'Correspondence information about the author Dr Padmini Srikantiah

      Summary
      Background
      Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

      Methods
      In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

      Findings
      Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9?6 [95% CI 3?6 ? 24]) and absence of an evening meal (2?2 [1?2?4?3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7?8 [95% CI 3?3?18?8], without evening meal; OR 3?6 [1?1?11?1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12?4 μg/g to 152?0 μg/g and MCPG ranged from 44?9 μg/g to 220?0 μg/g.

      Interpretation
      Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

      Funding
      US Centers for Disease Control and Prevention.

      Full paper available at; ​http://www.thelancet.com/journals/la...035-9/abstract
      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        See also:

        Outbreaks of Unexplained Neurologic Illness ? - Muzaffarpur, India, 2013?-2014




        ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
        Richard Horton, Editor-in-Chief The Lancet

        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

        Comment


        • #5
          Interestingly the first publication of the litchi hypothesis came in 2014 from TJ John: Acute encephalitis syndrome in children in Muzaffarpur: hypothesis
          of toxic origin CURRENT SCIENCE, VOL. 106, NO. 9, 10 MAY 2014 http://www.currentscience.ac.in/Volumes/106/09/1184.pdf
          and Recurrent outbreaks of hypoglycaemic encephalopathy in Muzaffarpur, Bihar CURRENT SCIENCE, VOL. 107, NO. 4, 25 AUGUST 2014 http://admin.indiaenvironmentportal....phalopathy.pdf
          and further developed in 2015 Litchi fruit contains methylene cyclopropyl-glycine CURRENT SCIENCE, VOL. 109, NO. 12, 25 DECEMBER 2015 http://www.currentscience.ac.in/Volumes/109/12/2195.pdf
          But it seems that John & the CDC team were not working in cooperation with each other
          Outbreaks of Hypoglycemic Encephalopathy in Muzaffarpur, India: Are These Caused by Toxins in Litchi Fruit? INDIAN PEDIATRICS VOLUME 53__MAY 15, 2016 http://www.indianpediatrics.net/may2016/399.pdf

          Interview with Dr. John

          Q:You were working with government and the other group of researchers was also working with government bodies. So how come the two groups never communicated?

          A: In 2013, after I made the diagnosis of encephalopathy and categorically refuted encephalitis, I was very open with government officers and paediatric colleagues. So other group knew about my conclusions ? such as the SK Medical College faculty, doctors of the Kejariwal maternity and child hospital in Muzaffarpur, AIIMS professors in Patna and regional medical research centre personnel. NCDC officers had been coming repeatedly for a few or even several years to investigate; in fact, their earliest known investigation was in 1995. Some research reports were already in medical journals. The point is, there was no unified line of command or communication ? each group had some hypothesis and supporting arguments. CDC investigators had made a presentation in Patna in 2013, stating that the disease could be encephalitis or could be encephalopathy and that both lines will be investigated by them. In other words, we all knew what each group was doing and what they were reporting. When I spoke to the health secretary and the executive director of NRHM they clearly responded that this concept (encephalopathy and hypoglycin) was new to them. The idea that children should not be fasting overnight came from such discussions. The risk factors of undernutrition and ?possible prolonged fasting? were already identified as amenable to intervention. I had held press meets in Patna and Muzaffarpur in 2014. All details were shared and there were press reports; I did not keep any [secrets]. - See more at: http://www.governancenow.com/news/re....z7EJvPKa.dpuf

          The lack of cooperation has led to a certain amount of controversy.
          Publishing on hypoglycemic encephalopathy, borrowing information without giving credit: is Current Science invisible? CURRENT SCIENCE, VOL. 109, NO. 5, 10 SEPTEMBER 2015 http://www.currentscience.ac.in/Volumes/109/05/0843.pdf

          'Litchi deaths' in Muzaffarpur are not mysterious and finding their cause is not a new discovery
          Newspapers reporting the findings of a new study linking litchi toxins to child deaths have ignored previous work with strikingly similar findings

          A new study connecting the consumption of the litchi fruit to the deaths of children in Bihar?s Muzaffarpur has received widespread attention in national and international media. The New York Times reported that the ?mystery of deadly outbreaks in India is solved? and the Times of India said that ?the mystery behind the outbreak of an unexplained neurological illness in Bihar?s Muzaffarpur, which had claimed nearly 100 lives each year till 2014, has been solved?.

          The study that these and other newspapers are referring to was conducted by a collaboration of scientists from Centre for Disease Control in the United States and its Indian counterpart, the National Centre for Disease Control. Published in the journal The Lancet Global Health on January 30, the study claims to be the ?first comprehensive confirmation? that the recurring outbreak of acute encephalopathy ? a general description for disorders of the brain ? is associated with toxic compunds found in the litchi fruit.

          Hypoglycin A and methylene cyclopropyl-glycine or MCPG are toxins in the litchi fruit, which the CDC and NCDC scientists said trigger low blood glucose levels in malnourished children who skipped evening meals leading to fatal outcomes.

          What is conspicuous by its absence in the newspaper reports are references to the strikingly similar findings reported a year ago in the Indian journal Current Science by a team of Indian scientists led by T Jacob John, epidemiologist at the Christian Medical College in Vellore.
          ...


          Twitter: @RonanKelly13
          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

          Comment

          Working...
          X