Centre set to train doctors involved in AES treatment
The Centre plans to impart special 20-day training in Delhi this month to doctors involved in the treatment of Acute Encephalitis Syndrome (AES), which breaks out annually in north Bihar ahead of the ripening season of litchi in March, according to officials aware of the development.
The state health department has sought details of doctors from Muzaffarpur, Sitamarhi, Motihari, Sheohar and Vaishali to undergo the training at top hospitals in Delhi, they added.
The AES killed over 150 children in Bihar last year. AES cases in Bihar’s litchi belt were misdiagnosed as Japanese encephalitis till the late 1990s since the symptoms and the seasonal outbreak of the two diseases are similar.
Paediatrician Dr G S Shahni published a paper in 2012, stating that all 55 AES samples sent to Pune’s National Institute of Virology had tested negative for any virus. This established the non-infectious origin of the disease. He proposed heat stroke as the probable reason for the syndrome. In 2013, Dr T Jacob John of Christian Medical College, Vellore, proposed the hypothesis of toxic origin found in unripe lychee seeds. He proposed that the toxin present in lychee (methylene cyclopropyl glycine, or MCPG) could possibly be the reason for these symptoms in severely malnourished children.
In 2014, the Centers for Disease Control and Prevention, the United States, conducted an investigation of 390 cases and found no confirmatory proof of any infection, which led them to call AES “non-infectious encephalopathy”.
The various non-infectious hypotheses proposed for this disease are pesticides/herbicides used to spray lychee orchards or agricultural fields; the toxin in lychee known as MCPG and hypoglycine, which causes hypoglycaemia in children who are starved, because of the lack of proper care by parents during peak litchi cultivation season.
A 2017 Lancet paper proposed all these theories behind the mysterious disease but ended up hinting at litchi toxin being the prime cause of the disease. But since the fruit is not just grown in Muzaffarpur, nor is intense heat confined to the region, acute malnutrition is likely to be the aggravating factor behind the vulnerability of children to the disease.
The National Family Health Survey, 2015-16, pointed out a high rate of malnutrition in children under five in Bihar, manifested mainly through wasting (acute malnutrition ) and stunting (chronic malnutrition).
A central team that visited Bihar last year had stressed on capacity building of doctors, nurses and paramedics to battle the AES outbreak. It had recommended the creation of a dedicated medical pool for management of intensive care units across hospitals.
“Nine doctors, including assistant doctors and resident doctors, and 12 nurses have been picked from the SKMCH [Sri Krishna Medical College and Hospital, Muzaffarpur] for the 20-day training this month,” said Sunil Kumar Shahi, the superintendent of SKMCH.