Acute encephalitis syndrome (AES) affects central nervous system, mostly in children and young adults. It starts with high fever, then hampers neurological functions causing mental disorientation, seizure, confusion, delirium, coma.
Currently, the state of Bihar is seeing an outbreak of the deadly neurological disease, which has claimed lives of at least 113 children in Muzaffarpur and the adjoining districts. And over 200 children in the state have been admitted to hospitals with high fever and other symptoms of the deadly viral infection.
What is acute encephalitis syndrome (AES)?
AES affects central nervous system, mostly in children and young adults. It starts with high fever, then hampers neurological functions causing mental disorientation, seizure, confusion, delirium, coma. The disease outbreak is usually reported during monsoons (June-October). But the incidence is also reported during April-June in Bihar.
What causes AES?
This syndrome is very complex. It can be caused by virus, bacteria, fungi, and a range of agents. Japanese encephalitis (JE) virus is the most common cause of AES in India, with union health ministry estimate attributing 5-35 per cent cases due to JE. But the syndrome is also caused by scrub typhus, dengue, mumps, measles, even Nipah or Zika virus. In several cases though the cause of AES remains clinically unidentified.
Relation between Hypoglycaemia, Children and AES
Government officials claim AES is a syndrome not disease, and cause of death in these children was found to be prolonged hypoglycaemia that witnessed delayed treatment. In 2014 research paper titled ‘Epidemiology of Acute Encephalitis Syndrome in India: Changing Paradigm and Implication for Control’, coauthored by six researchers, a parallel was drawn between Muzaffarpur and Vietnam’s Bac Giang province where undernourished children were suffering from AES and hypoglycaemia that coincided with litchi orchards in neighbourhood.
“The possible association with some toxin in litchi or in environment need to be documented. Methylene cyclopropyl glycine (MCPG) which has been known to be a content of litchi fruit has been shown to cause hypoglycaemia in experimental animals,” the study stated. Several children in Muzaffarpur who suffer from AES before 2014 have a history of visit to litchi orchards, the study found. The impact is worse on undernourished children who remain hungry for several hours.
Dr Ragini Mishra, Bihar state surveillance officer, says if toxins from Litchi were affecting children, then the AES cases should remain consistent each year and affect children of all socio-economic strata. This year’s deaths have all been recorded in lower income groups. “Last year we had very few cases, mortality was less. We believe there is some correlation between high temperature and AES. Last year hot days were followed by rain showers. This year, the heat has been prolonged with no spells of rain,” she told The Indian Express. Government data shows, at least 98 per cent of children with AES getting hospitalised also suffer from hypoglycaemia. Maximum children affected fall under 0-2 age bracket. Mishra adds that an AIIMS Patna study is pointing at presence of enterovirus. “It may have some co-relation. We are yet to study in detail,” Mishra said.
Encephalitis or Chamki fever: Treatment
People suffering from encephalitis need to be treated urgently. Treatment may include antiviral medication, steroid injections among others to support the body, relieve the symptoms. Other treatment options are – bed rest, plenty of fluids, anti-inflammatory drugs to relieve the symptoms such as fever and headache.
There is no cure for the disease in Allopathy (Modern Medicine). However, safe and effective vaccines are available to prevent encephalitis.
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