Investigation of child deaths after consumption of lychee in Bihar state
Indian child picks lychees from a tree. The fruit has been found to be dangerous to undernourished children. Photograph: Jaipal Singh/EPA
“Researchers confirmed that a toxic chemical in the fruit of the Asian lychee tree is responsible for outbreaks of a fatal brain sickness in children in India’s Bihar state, where the fruit is commercially grown.
Methylene cyclopropyl-glycine (MCPG) was detected in lychee fruit by a team of virologists led by T Jacob John at the Christian Medical College (CMC), Vellore, in India. The findings were published in Current Science in December.
The chemical is akin to another toxin found in ackee, a West Indian fruit. Both lychee and ackee come from the soapberry family of plants.
MCPG is known to cause hypoglycemic encephalopathy, a metabolic illness that affects the brain when body sugar levels are low due to fasting or undernourishment. Earlier, viral encephalitis was suspected to be causing the deaths. “When no virus was detected, researchers suspected a toxin from pesticides or from the fruit itself,” said John.
In 2013, at the request of India’s ministry of health and family welfare, John camped in Muzaffarpur, Bihar, where many of the deaths had occurred. “Children there were found having low blood sugar levels which aided metabolic diseases,” John said.
It was the March of 2014 when the RMNCH+A (Reproductive,
maternal, neonatal, child health + Adolescent) program under the National
Health Mission – GoI, brought me to Bihar as a senior adviser to the Ministry of
Health & Family Welfare, Govt. of Bihar. My position was a BBC one funded by the Bill & Melinda Gates Foundation.
It took me two weeks to find a nice place in the Patliputra
Colony area in Patna and settle down with my newly shifted furniture and other things (my
family was yet to join me at that point in time). The regular news paper vender
of the building Satyanarayan, approached a few more days later with the
proposition of supplying me the regular doses of happenings with the printed
dailies. I obliged.
I clearly remember the first news paper I had received at my
front door on a mid March morning had this news of children dying in and around
Mujaffarpur area in Bihar for unknown reason.
That day in the State Health Society, Bihar we had a long
discussion in and around the issue. State Immunization Officer Dr Sinha, Dr
Tapaswi Puwar– Deputy Director – SRU (State RMNCH+A Unit) and me (Sr Adviser –
Public Health Communication SRU). I was an emergency and we had to take
decisions fast. Dr Sinha suggested about involving experts for immediate
research on the matter. I remember me and Dr Tapaswi Puwar consulted with the SRU
Director Dr Hemant Shah and figured out the best person for the job. Dr T Jacob
John from the Christian Medical College (CMC).
Five days from that discussion we again meet in Dr Sinha’s
cabin in SHS, Bihar. But this time we had Dr Jacob John with us. We started the discussion;
Dr John sipped his coffee and said, ‘Oh, even last year I was here to initiate
the research on this, on the request of Govt of India……but then the fund I was promised
by the MoHFW - never came, the initial few thousands which they transferred evaporated
soon and I had to stop the work,’ He shrugged and continued…. ‘We still do not
know whether it is a toxin from pesticides or not, as we couldn’t complete our
work…..it is so sad…..’
I had to intervene and directed the discussion towards
action; we then talked about the job in hand and arranged a visit for him. Sometime
later as he departed we started the second part of the discussion. This one was
about how to fund the next level of work and engage Dr Jacob John in the
project. Though we could not see any immediate light, but in our mind and heart
all three of us knew - we have to initiate this if not for anything else but
for saving lives… lives of hundreds of children of Bihar.
I do not want to write about how the funding was arranged
and how the project was started and advanced……
But after innumerable visits, meetings and several hurdles
later today as I scanned the morning newspaper that Satyanarayan has slipped
through my door and find this news about - Dr T Jacob John’s research report is
finally presented to the Govt of Bihar I feel immensely happy and content to be
a part of something meaningful.
January 14th 2016
Though I was thoroughly involved in the project throughout but surprisingly I was so happy today. Reading through the newspaper, it was almost like a momentary vision for me today…..I am suddenly happy about many things including that one decision which I took some 10 years back to leave the high flying creative career in advertising and join the social sector, which in no time turned into a public health career for me.
I share the piece of news with you all – though it is much
more than a piece of news for me:Though I was thoroughly involved in the project throughout but surprisingly I was so happy today. Reading through the newspaper, it was almost like a momentary vision for me today…..I am suddenly happy about many things including that one decision which I took some 10 years back to leave the high flying creative career in advertising and join the social sector, which in no time turned into a public health career for me.
Investigation
of deaths in Bihar state indicates children with low blood sugar are vulnerable
because toxins in lychee interfere with food metabolism
Indian child picks lychees from a tree. The fruit has been found to be dangerous to undernourished children. Photograph: Jaipal Singh/EPA
“Researchers confirmed that a toxic chemical in the fruit of the Asian lychee tree is responsible for outbreaks of a fatal brain sickness in children in India’s Bihar state, where the fruit is commercially grown.
Methylene cyclopropyl-glycine (MCPG) was detected in lychee fruit by a team of virologists led by T Jacob John at the Christian Medical College (CMC), Vellore, in India. The findings were published in Current Science in December.
The chemical is akin to another toxin found in ackee, a West Indian fruit. Both lychee and ackee come from the soapberry family of plants.
MCPG is known to cause hypoglycemic encephalopathy, a metabolic illness that affects the brain when body sugar levels are low due to fasting or undernourishment. Earlier, viral encephalitis was suspected to be causing the deaths. “When no virus was detected, researchers suspected a toxin from pesticides or from the fruit itself,” said John.
In 2013, at the request of India’s ministry of health and family welfare, John camped in Muzaffarpur, Bihar, where many of the deaths had occurred. “Children there were found having low blood sugar levels which aided metabolic diseases,” John said.
Only undernourished children living near lychee orchards
appeared to suffer during May and June, when the fruit is harvested. “The
victims had signs of brain cell damage and seizures, indicating that a toxin
and not just undernourishment was causing the disease,’’ John said.
MCPG forms compounds with carnitine and coenzyme A, making
them less available for important metabolic reactions in the body. When a
person is fasting, stored glycogen is released initially for energy production.
Later, body fat is mobilised and this requires the breakdown of fatty acids
aided by carnitine and coenzyme. “When this metabolism is impaired,
hypoglycemia develops,” Maya Thomas, a paediatric neurologist at CMC Vellore,
said.
The toxin is seen in
high concentrations in the seed and semi-ripe pulp. “Children who are
malnourished are most vulnerable as they have low glycogen stores,” Thomas
said.
While MCPG was known to be present in lychee seeds, the
study established its presence in the flesh of the fruits as well, said John.
Immediate treatment for victims includes administration of
glucose, John added: Villagers have been told to let children eat the fruit
only after a meal.”
Epilogue:
Well this report was published on 14 January 2016 and today as I finally post
this write up when the lychee season in Bihar is on a full swing…..
I happily add this epilogue – though by mid May last year
over 39 child deaths were reported, this year no death has been reported in
Mujaffarpur or anywhere in the nearby districts and blocks. I give the credit
to the rigorous work went behind the study, to the finding and the key solution and to the strategic public health
communication of ‘glucose administration’.
Victor Kalyan Ghoshe
Sr. Adviser, State RMNCH+A Unit, Bihar
Sr. Adviser, State RMNCH+A Unit, Bihar
