Since the 1990s, the inexplicable deaths of numerous children in Muzaffarpur (Bihar) is haunting people who live in those areas. Over 100 children had lost their lives after they attained a strange brain fever and most of their deaths have been associated with malnutrition and low blood glucose level (hypoglycemia). This has led many scientists of the world to work on unraveling this mystery.

It was reported that hypoglycaemic encephalopathy (low blood glucose level) was found to have occurred in the majority of cases in Muzaffarpur. Hypoglycaemic encephalopathy is not related to encephalitis which is characterized by normal blood glucose levels. In the case of encephalitis, fever occurs on the first day followed by brain dysfunction, whereas children with hypoglycaemic encephalopathy develop fever only after the onset of brain dysfunction (some might not even develop a fever). One important distinguishing criterion is the WBC count in the cerebrospinal fluid which is comparatively high in encephalitis.

The most intriguing part of this mystery is the association of litchis to the deaths of children in Muzaffarpur which is popular for its Litchi production. Since the issue instigated curiosity in many scientists worldwide, they strived to discover the cause of this strange and deadly neurologically illness. In 2017, it was confirmed that a toxin called methylene cyclopropyl glycine (MCPG) found in litchis was responsible for the illness.

Healthy children make use of glycogen that is stored in their liver when their glucose level goes down but undernourished children lack sufficient glycogen to be converted to glucose. Undernourished children solely depend on an alternative pathway called fatty acid oxidation to gain energy. But MCPG present in litchis blocks this pathway in children who consumed litchis (without consuming meals). The toxin MCPG present in it thus harms the brain causing drowsiness, unconsciousness, disorientation and even death. The risk is higher in undernourished children who eat litchis during the day time and go to sleep on an empty stomach.

It is imperative to prioritize prevention and hence it must be ensured that children consume nutritious food and avoid eating litchis before going to bed. This prevention strategy stated by Dr Jacob John’s team has proved to be effective and a surge in the number of cases with hypoglycaemic Encephalopathy is witnessed since 2015. Though litchis play a role in causing brain dysfunctions, malnutrition is unarguably the most significant cause of this illness. It is important to note that well-nourished children do not develop hypoglycaemic encephalopathy and hence eradicating malnutrition in children can drastically prevent child deaths in Muzaffarpur.

“Hunger and malnutrition have devastating consequences for children and have been linked to low birth weight and birth defects, obesity, mental and physical problems, and poorer educational outcomes”- Marian Wright Edelman

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