Acute Encephalitis Syndrome (AES)

Background :- One among three long-standing mystery diseases listed in Wikipedia is acute encephalitis syndrome (AES) in Muzaffarpur, Bihar. This disease has remained for over two decades without determining a cause for it; hence it is called mystery disease. It occurs as annual seasonal outbreaks during the months of April – July, affecting hundreds of children with 40–60% mortality. Studies documented that cases coincided spatially and temporally with lychee cultivation. My investigation suggests that lychee consumption is the main cause of acute encephalitis syndrome.

Objective:- There are hundreds of children deaths due to acute encephalitis syndrome in Muzaffarpur due to lack hospital facilities, illiteracy, poor mental health and inadequate nutrient supply.

Material and Methods:- Study design In 2014, NCDC and US CDC investigated this syndrome, using hospital-based clinical surveillance, an epidemiological case-control study, and comprehensive and novel laboratory testing methods on human biological and environmental specimens to determine risk factors associated with this illness, assess the aetiological role of naturally occurring toxins such as MCPG and hypoglycin, and exclude the role of novel infectious pathogens, selected pesticides, and toxic elements.

Hospital-based clinical surveillance:- Surveillance was done at the SKMCH and the KDKMH, the chief referral medical centers in Muzaffarpur, India.Demographic and clinical data were collected with standardised questionnaires.

Case-control study:- For each Case and controls were asked about consumption of food items, food washing, water sources, and other exposures, including time spent in agricultural fields. Calculate a socioeconomic index according to the methods of the National Family Health Survey, A child was defined as wasted if the Z score was more than 2 SD below WHO Child Growth Standard.

Environmental specimen collection. Between May 19, and June 13, 2014, litchi fruit samples were collected from orchards in the five blocks of Muzaffarpur.

Laboratory testing:- Specimens from 2013 and 2014 for metabolites of hypoglycin A and MCPG using liquid chromatography-tandem mass spectrometry. In a collaboration between the US Department of Agriculture (USDA) and the US CDC, a quantitative assay was designed to assess MCPG and hypoglycin A content in soapberry arils.

Results:- In animal experiments, MCPA and MCPG have been shown to induce encephalopathy and hypoglycaemia. The encephalopathy is explained by the mitochondrial inhibition of fatty acid-oxidation and accumulation of toxic metabolites. Our hypothesis is that the Muzaffarpur AES is caused by MCPG in lychee.

Conclusion:- Knowing that fatty acid metabolism is deranged, treatment modalities are possible to save lives. Ensuring adequate nutritional status in young children will prevent this disease. If and when the lychee connection is confirmed, children’s behaviour modification can further help prevention.

new study also suggested Agrochemicals, including endosulfan, caused brain damage among children, says new report