MUZAFFARPUR, India – Every year, a mysterious disease stalks the area around the East Indian city of Muzaffarpur, seemingly randomly killing children – there and nowhere else.
Most of the time, poor children under the age of 10 seem to sleep soundly and wake up to high fever and brain swelling, leading to seizures, seizures and one-third of death – often within 24 to 36 hours.
Two years ago, researchers solved the puzzle by saying that the cause was the precious lychee fruit growing around this area during the hottest months of the year. A lychee chemical caused hypoglycaemia, a catastrophic drop in the child's blood sugar when consumed on an empty stomach. This was more likely in a malnourished child without glucose reserves, the chemical form that takes on sugars to be digested by the body.
Until this year. There were hundreds of cases again – 719 since Monday, with 152 deaths – all among poor children here in the Muzaffarpur Lizard Belt in a densely populated area of the state of Bihar. And this time, doctors say they find many cases where lychees were not a factor.
The Treatment Epicenter is the Sri Krishna Medical College and Hospital in Muzaffarpur, where 102 deaths occurred that year. This equates to a 27 percent mortality rate for the disease at this hospital, according to BrajMohan, the physician responsible for a pediatric recovery ward. On Friday, there were 65 children sharing 40 beds in their ward, and 16 mattresses in a corridor accommodated 30 others.
Those were the lucky ones who survived the hospital's three intensive care units.
Most Children Those who got sick this time were less than 5 years old, and many were only 1 or 2 years old and still breastfeeding, said Drs. BrajMohan, who uses only one name. "At this age, they hardly ate lychees," he said.
Many other doctors and hospital officials are also skeptical of the lychee theory.
"It must be some kind of virus or bacteria, we only have recourse. I have not discovered it yet," said JP Mandal, who, like Dr. BrajMohan is a pediatrician and medical professor. "They have to transport samples to labs at minus 80 degrees Celsius when the outside temperature is 45 degrees – no wonder we did not find them," he added. (Forty-five degrees Fahrenheit are 113 degrees Fahrenheit.)
There is even disagreement over the name of the disease. Scientists call it Acute Encephalopathy Syndrome or A.E.S., while Indian officials insist on calling it Acute Encephalitis Syndrome. Encephalitis indicates an infectious agent, and the disease is similar to Japanese encephalitis, a mosquito disease common in the East Indies. However, decades of search have found no microbe responsible for what the locals often just call "lychee disease". Even in the seasons, when hundreds fall ill, there is no accumulation of cases in families or communities – usually only in one village, which undermines the theory of infectious diseases.
But if lychees are to blame, there are some questions why there are no cases in other areas where lychee is grown, in India or in other countries. And what explains the deaths of children too young to eat fruit or of children who died outside the lychee season?
"Why we have so many cases of hypoglycaemia needs to be investigated," said Superintendent of Sri Krishna Hospital Sunil Kumar Shahi. "But the lychee has nothing to do with it."
The landscape around Muzaffarpur accounts for up to 70 percent of Indian litchi production, which is the second largest producer of fruits after China. It is easy to find families affected by the disease here, but it is certain that lychees are not the cause.
"We all eat lychee here," said Kamini Kumari, whose three-year-old daughter Anupa got sick with cramps, but recovered after days at the hospital. "But we will not let the kids do it on an empty stomach."
wife. Kumari lives in Minapur Block, an agricultural area where 47 A.E.S. Cases this year. According to local authorities, 13 children have died.
In another village in Minapur, a 15-minute drive from Ms. Kumaris, Rani Devi lost her 5-year-old daughter Gunja Kumari to the disease this month. She went to bed with an empty stomach, but had not eaten any lychee that day, said Mrs. Devi; She woke up convulsively and died the next day.
"She was the healthiest of my four children," said Ms. Devi, 24.
Aakash Shrivastava, a scientist at the Indian National Center for Disease Control author of the Lancet report, said high-ranking officials had ordered him not to allow the outbreak to discuss. Repeated attempts, the director of the center, Dr. med. Sujeet Kumar Singh, to ask for an opinion, were unsuccessful.
Officials from the Centers for Disease Control, stationed at the US Embassy in New Delhi, have declined, according to a message, to comment on the outburst spokeswoman.
Arun Shah, a Muzaffarpur pediatrician and one of the authors of a early scientific article on the disease, said that scientists are still convinced of the lychee theory – even if this has become problematic. He blamed the government's negligence for the increase in this year's cases.
"The government simply did not do what it should have done," Dr. Shah. "They did not do anything. At first they were paying attention, but in 2017, 2018, there were only a few cases – only 25 cases last year, and they became complacent, "he said. Kaushal Kishore, a state health ministry official, denied that the authorities had done so not to prosecute the litchi compound. "Nobody is aware of the causative factor, the pathogen has not been identified," he said. "How can we blame a particular food? It must be based on research and evidence, and there is no evidence.
The authorities went from house to house in the affected area, looking for children with symptoms and telling parents what to do, Mr. Kishore said. In recent days, the deaths from the disease have gradually declined.
Hospital admissions for the disease have also declined as officials spread the word about first-aid measures that parents could easily administer: to instill sugar and salt into an affected child immediately. If the symptoms persisted, they should quickly take the child to a hospital where intravenous infusion of dextrose and electrolytes was the main treatment.
With such a devastating disease, simple healing is one of the many difficulties that AES brings
"I think we'll find it multifactorial, but so far it's a mystery," Dr. Mandal. "A puzzle that we have to solve."