Lychee is a tropical fruit, with about 7 Lychee giving your daily dose of Vitamin C. It’s a sweet fleshy fruit, which if had in large amounts can cause stomach cramps and loose motion.

But today I will tell you about a mysterious disease surrounding Lychee.

Lychee contains many phytochemicals. The seeds contain methylene cyclopropyl glycine (MCPG).A chemical with a suspicious role in lowering blood glucose to dangerous levels.

MCPG Hypoglycemia 

Hypoglycemia is a condition of decreasing blood glucose, which may have acute and long-term effects. For the growing brain, it’s really bad because glucose is the only brain food. The brain survives on glucose as its main energy molecule.No sugar, the brain can stop!

Acute effect of low blood sugar includes convulsions and even death. Chronic hypoglycemia can lead to a long-term poor neurodevelopmental outcomes in children.

The True story ..stranger than fiction

Children came from lychee-growing areas, with convulsions in the early hours of the morning. Then before they could be stabilized, they tragically died. Nothing seemed to work. Till the blood workup of a few older children who could fight it longer, came back.

These outbreaks of encephalopathy occurring in Indian and Vietnamese children were traced back to Lychee.

Several investigation teams found the condition related to hypoglycin A and MCPG toxicity. Malnourished children eating lychees (especially unripe ones) on an empty stomach and remaining empty stomachs even after that may have life-threatening hypoglycemia. Lychee may also contain unusual amino acids. which influence gluconeogenesis and β-oxidation of fatty acids, exacerbating the acute illness.

What happened: Details

• An unusual, rapidly deteriorating outbreak of acute encephalitis syndrome (AES) with high case fatality was reported from Kaliachak- I, II, and III Blocks of Malda District of West Bengal in the month of June 2014 affecting 72 children with 34 deaths.
• Children belonged to age groups from   9 months to 10 years, belonging to the low socioeconomic background of the lychee growing belt of Malda.
• Male :(65% approx).

The case Fatality Rate was 47.2%.

The main presenting features:

• Sudden onset of convulsions (100%) in the early hours of the morning
• Rapid progression to unconsciousness (100%) 
• Decerebrate rigidity (47%).
• Fever was present in around one-third of cases.
• Hypoglycemia (low blood sugar) and leukocytosis(increase in white blood cells ) were two predominant  laboratory features

Clinical samples subjected to molecular and serological testing were all found negative for known viruses causing acute encephalitis.

What treatment did they receive?

• All cases were treated with 10% dextrose infusion in addition to standard treatment protocol with anticonvulsants, anti-edema measures like 20% mannitol, antipyretic (acetaminophen) along with other necessary measures. Serial blood glucose monitoring was done.
• At first contact, health care workers and ward sisters were advised, to start dextrose(a type of sugar ) as soon as they saw the cases as the time from reporting to the fatal outcome was horrifyingly low.
• Dextrose helped correct the hypoglycemia and helped reduce the fatality in the later reported cases.

Conclusion

Genetically susceptible, malnourished child ,who had litchi in large quantity followed by prolonged period of fasting can lead to metabolic encephalopathy  .

The CDC report recommended that parents check , lychee consumption in children .Definitely have an evening meal, elevating blood glucose levels .Both these may help in avoiding this horror.

2 strange unexplained events:

• The cases were more during the scorching days. Declined after rain showers.
• Though no identifiable virus was not found and exact etiology couldn’t be identified, that hypoglycemia had a role to play is undisputed.

Research continues to find out the exact reasons. Till then it’s better to be safe.Increasing education and awareness about the condition in litchi growing belts have prevented recurrence of cases .

Disclaimer:

All information in this post is for information purposes and is to be taken with respect to the reference provided.

References:

1)Research paper: Epidemiological Investigation of an Outbreak of Acute Encephalitis Syndrome (AES) in Malda District of West Bengal, India. Available from: https://www.researchgate.net/publication/277249892_Epidemiological_Investigation_of_an_Outbreak_of_Acute_Encephalitis_Syndrome_AES_in_Malda_District_of_West_Bengal_India

Bhaswati Bandyopadhyay1*, Debjit Chakraborty2, Sibarjun Ghosh3, Raghunath Mishra4, Mehebubar Rahman1, Nemai Bhattacharya1,Soleman Alam5, Amitabha Mandal5, Anjan Das6, Abhijit Mishra6, Anand K Mishra7, Arvind Kumar7, Surya Haldar1, Tarun Pathak6, NepalMahapatra6, Dilip Kumar Mondal5, Dipankar Maji8 and Nandita Basu1

2) “Litchi virus kills 8 kids in Malda”. Times of India. 8 June 2014. Retrieved 12 June 2014.

3)https://www.nytimes.com/2017/01/31/world/asia/lychee-litchi-india-outbreak.html?_r=0

4)https://www.theguardian.com/global-development/2016/jan/14/lychee-fruit-deaths-malnourished-children-india