title: Outbreaks of unexplained neurologic illness - Muzaffarpur, India, 2013-2014.
abstract: Outbreaks of an unexplained acute neurologic illness affecting young children and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious encephalitis and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory encephalopathy, possibly caused by a toxin. A common laboratory finding was low blood glucose (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic encephalopathy and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for methylenecyclopropylglycine (MCPG), a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current public health recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of hypoglycemia in ill children.
authors: Aakash
authors: A
authors: Shrivastava
authors: Padmini
authors: P
authors: Srikantiah
authors: Anil
authors: A
authors: Kumar
authors: Gyan
authors: G
authors: Bhushan
authors: Kapil
authors: K
authors: Goel
authors: Satish
authors: S
authors: Kumar
authors: Tripurari
authors: T
authors: Kumar
authors: Raju
authors: R
authors: Mohankumar
authors: Rajesh
authors: R
authors: Pandey
authors: Parvez
authors: P
authors: Pathan
authors: Yogita
authors: Y
authors: Tulsian
authors: Mohan
authors: M
authors: Pappanna
authors: Achhelal
authors: A
authors: Pasi
authors: Arghya
authors: A
authors: Pradhan
authors: Pankaj
authors: P
authors: Singh
authors: D
authors: D
authors: Somashekar
authors: Anoop
authors: A
authors: Velayudhan
authors: Rajesh
authors: R
authors: Yadav
authors: Mala
authors: M
authors: Chhabra
authors: Veena
authors: V
authors: Mittal
authors: Shashi
authors: S
authors: Khare
authors: James J
authors: JJ
authors: Sejvar
authors: Mayank
authors: M
authors: Dwivedi
authors: Kayla
authors: K
authors: Laserson
authors: Kenneth C
authors: KC
authors: Earhart
authors: P
authors: P
authors: Sivaperumal
authors: A Ramesh
authors: AR
authors: Kumar
authors: Amit
authors: A
authors: Chakrabarti
authors: Jerry
authors: J
authors: Thomas
authors: Joshua
authors: J
authors: Schier
authors: Ram
authors: R
authors: Singh
authors: Ravi Shankar
authors: RS
authors: Singh
authors: A C
authors: AC
authors: Dhariwal
authors: L S
authors: LS
authors: Chauhan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007194:India / Q000453:epidemiology; D007223:Infant; D032125:Litchi / Q000633:toxicity; D008297:Male; D020258:Neurotoxicity Syndromes / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
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