In a tragic incident in the Muzaffarpur district of North Bihar, at least 69 children within a week have lost their lives due to the outbreak of a disease, colloquially known as ÂChamki FeverÂ. Unofficial records claim the total number of deaths is over 105 in the last ten days and over 100 children are fighting for life. On Monday itself, 20 children succumbed to severe high fever, nausea, and headache in Sri Krishna Medical College Hospital (SKMCH, a government undertaking) and Kejriwal Hospital (a private entity) at Muzaffarpur.

Several reports in media cite ÂAcute Encephalitis Syndrome (AES) as the potent reason behind the deaths of children between the ages of 4-12 years. Doctors say there is a serious deficit of Glucose known as Hypoglycemia in the bloodstreams of the affected children.

According to a research published in the Indian Journal of Medical Research (IJMR), between 2008 and 2014, there have been more than 44,000 cases and nearly 6000 deaths from ÂEncephalitis in India, particularly in Uttar Pradesh and Bihar. It also says, in 2016, there has been a rise in encephalitis, with over 125 children reported to have died in one hospital in Gorakhpur, Uttar Pradesh alone.

On the other hand, some health experts, doctors, and politicians in Bihar are also drawing connections between Litchi fruit and death of the children. Actually, this theory has been inspired by research done by the prestigious health journal, The Lancet, in 2017, which says that the consumption of Litchi empty stomach has led to mortality of hundreds of children. Muzaffarpur is known as the hub of producing maximum Litchi in the country. Now there are government advisories to the parents not to feed Litchi to their children. 

In an interview given to The Hindu, Chief Minister of Bihar Nitish Kumar said, ÂIt generally hits those children who go to sleep empty stomach at night and eat litchis fallen on the ground. Earlier, three different teams of doctors had reached three different conclusions about the reason for childrenÂs deaths in summer season in Muzaffarpur last year, very few deaths were reported because an extensive awareness drive was launched.Â

However, there are contrary arguments against the theory of Litchi and AES. In a telephonic conversation, a well-known Pediatrician at SKMCH, MBBS, MD (Pedia), Dr. Gopal Shankar Sinha spoke extensively and exclusively to ÂThe India SagaÂ.  

ÂHeat-stroke the main cause, not LitchiÂ

In the last two weeks, there is a steep rise in the temperature in the Northern part of India. Last week, Muzaffarpur, recorded 42 degree Celsius with humidity more than 60%, posing a great threat for the children who are exposed to the heat wave during the day and also at night.

Dr. Gopal Shankar Sahni, Head of Pediatrics Department at SKMCH, is not quite convinced with the association of Litchi and death of 54 children. He said, ÂI donÂt think there is any connection with Litchi and death caused by Chamki Fever. It is more of a hypothesis. It is caused due to severe Âheat stroke in the month on May-June every year in Muzaffarpur. It is the most adverse season for those children who belong to the poor financial background and suffer malnourishment at large scale. I have been working on this crisis since 2005. TodayÂs temperature at Muzaffarpur is more than 42 and humidity more than 60%. It makes the malnourished children vulnerable to the threat of Chamki fever. At least 30 patients have been admitted since morning. I forecast that the number of patients is going to be increased up to 50 till next morning. Next four days are going to be extremely critical and dangerous for us as the Monsoon is not going to come anytime sooner than 22nd June.Â

However, The Lancet in its case-study, ÂThe enigma of litchi toxicity: an emerging health concern in southern AsiaÂ, says, ÂIngestion of the hypoglycine-rich fruit of Ackee, a relative of lychee (Litchi), can induce a dose-dependent toxic hypoglycemic encephalopathy in poorly-nourished children. The syndrome is best known from Jamaica, where ackee is widely eaten and occurs most frequently in 2- to 10-year-old children, who develop severe hypoglycemia and metabolic acidosis.Â

The research says that the cause behind the death of the children is ÂhypoglycemiaÂ, low levels of glucose in the blood vessels and brain. Most of the affected children belong to a poor economic background. Malnourishment poses a great threat. Often they used to fed over the unripe fruits of Litchi and develop the syndrome of Chamki fever.

Contrary to the above theory by The Lancet, Dr. Sahni believes, ÂThe Lancet is a very prestigious journal but I too have my own findings. They have confused the research by comparing the Jamaican Ackee fruit and Indian Litchi and Vietnamese Litchi. Both the fruits, Ackee and Litchi, belong botanically to the same family. The Jamaican fruit has ÂMCPGÂ. Its consumption causes the deficit of glucose level in the body. Jamaica has a history of losing its children due to this very reason. In India, researchers have attached the same hypothesis that Litchi also contains the same chemicals, causing death to the children.

ÂIn the year 2014, 700 such cases were registered. However, for the next four years until 2018, only 30-40 cases were recorded. Does it imply that the children did not consume Litchis during those four years? The symptoms of Jamaican Ackee fruit is extreme vomiting and severe pain in the abdomen. However, here at Muzaffarpur, no such signs are recorded in Chamki-affected children. In 90% of the Chamki cases, not only glucose level but sodium and potassium level also differ. Consumption of Jamaican Ackee leads to a lower level of glucose in the childrenÂs body. In India, not only glucose, multiple supplements are missing in the blood and it does clearly sync with the symptom of heat stroke. There is electrolyte imbalance in malnourished children.Â

ÂNo more deaths if Monsoon comes todayÂ

ÂMonsoon is the best treatment for this epidemic. In one of my research papers and articles published in Journal of Indian Medical Association (JIMA) in February this year, I have mentioned how heat stroke has played a villain in the increasing number of deaths of the children in Muzaffarpur. In the history of Muzaffarpur, the most severe epidemic occurred in 1995 and 2005 when more than 500 and 100 deaths occurred, respectively. It approaches when the environmental temperature approaches 38°C-44°C and remained sustained for 3 to 4 days. The outbreak is 100 percent associated with high environmental temperature and humidity. Heat stroke is a life-threatening medical emergency- defined clinically as core temperature >40°C accompanied by central nervous system dysfunction. My experience says if today Monsoon strikes in Bihar, there will be less or no cases of Chamki fever.Â

ÂNot AES, it is Metabolic EncephalopathyÂ

Dr. Gopal Shankar Sahni does also not align with the clinical term of Acute Encephalitis Syndrome. On the contrary, Dr. Sahni says, it is a case of Metabolic Encephalopathy. ÂEncephalopathy implies there is no infection in the human brain. The presentation of Encephalitis and Encephalopathy are almost same; both have same symptoms of acute fever, but the former causes infection to the brain, however, the latter occurs due to weak body mechanism and affects the brain. All the bi-chemical findings lead to the symptoms of heat stroke, not AES or Litchi consumption.Â

(Sources- Inputs on phone by Dr. Gopal Shankar Sahni {Muzaffarpur}, research papers published in Lancet Global Health, Journal of Indian Medical Association (JIMA), Indian Journal of Medical Research (IJMR), Research Gate, local newspapers Bihar and Ministry of Health.)