The ICU at Sri Krishna Medical College and Hospital in Muzaffarpur. (Express photo by Ritesh Shukla)The Acute Encephalitis Syndrome (AES) outbreak in Bihar’s Muzaffarpur has claimed the lives of over 130 children so far, with two more deaths reported on Sunday. Dr G S Sahni, head of the department of paediatrics at Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, speaks to Santosh Singh on the reasons for the spurt in the number of cases and what is distinct about the climate of Muzaffarpur that makes its residents susceptible to AES. Excerpts:
Is there anything distinct about AES cases this year?
This year, of over 450 AES registered at SKMCH so far, 90 per cent are cases of hypoglycaemia (low blood sugar levels). In previous years, such cases were 60-70 per cent of the total. That apart, the pattern has been more or less the same. The disease is characterised by high or no fever, vomiting and convulsions. Hypoglycaemia and electrolyte imbalance are common reasons for the deaths.
Heat and humidity are often linked to AES. But why did it break out so severely in Muzaffarpur when the weather condtions are common across the state?
Temperature in excess of 38 degrees Celsius coupled with 60 per cent humidity — not just during the day but also at night — make Muzaffarpur distinct and susceptible to AES. While places like Jaisalmer are hot at daytime, the nights are cool. After the 1934 earthquake, Muzaffarpur and some adjoining north Bihar districts became low-lying areas, often becoming bowls of humidity…. When I joined the hospital in 2005, there was an AES outbreak. During treatment over the years, heat, humidity and malnutrition were found to be common factors.
Dr G S Sahni, HoD of Paediatrics at SKMCHWhat is the difference between AES incidence in Gorakhpur and Gaya and Muzaffarpur?
Gorakhpur and Gaya have mostly reported Japanese Encephalitis (JE) cases. Muzaffarpur’s AES cases can be categorised under encephalopathy, characterised by seizures, declining ability to concentrate and personality change. But there is no inflammation of the brain, as in JE. Teams from the National Institute of Virology, Pune, Centers for Disease Control, Atlanta and Christian Medical College, Vellore, which have visited Muzaffarpur in the past, have also concluded that cases here are encephalopathy. They have backed our observation on heat, humidity and malnutrition.
Explained: What causes AES? What makes Bihar so vulnerable?
What were the test results of blood samples taken from Muzaffarpur?
The tests found it is not a viral infection. Only symptomatic treatment can be provided to AES patients. The sooner a patient reaches hospital, the more is the chance of survival. Convulsions mean brain cells are being damaged. Awareness of AES management with oral glucose (ORS) at home and intravenous glucose at the PHC or the nearest available doctor can help. SKMCH has high AES mortality rate only because several patients are brought late.
Is there any connection between litchi and AES?
My first-hand experience shows there is little connection. We have reported a one-year-old child’s death due to AES. Could he eat litchi? Most deaths are in age group of two- to three-and-a-half years, when children can hardly eat litchi on their own. Also, litchi toxin can increase SGPT (a liver toxin) level abnormally, but AES patients’ SGPT levels were found marginally high. Litchis are not available after the second week of June but AES cases can be reported till mid-July if there are no rains.
Litchi toxin can at best be a contributory factor for low sugar levels. Over 80 per cent of our patients have no history of eating litchis.
Acute encephalitis syndrome (AES) explained: Definition, cause, and its contrary theories
What are the health effects on AES survivors?
We have found about 3 to 4 per cent cases of memory impairment and temporary loss of eyesight.
How can SKMCH be better prepared to deal with AES?
We have only a 14-bed paediatric ICU. We have converted one ward into ICU and used other ICUs to prepare 66 beds. We are happy that the Central government has sanctioned a 100-bed ICU, which should be ready by next summer. Also, PHCs have to be improved.
