Outbreak in Bihar was probably encephalopathy rather than encephalitis, says Dr. Dhole, from India

Previous research pointed to a combination of factors, in particular metabolic changes related to the consumption of large amounts of lychee by malnourished children, in prolonged fasting, without adequate medical care in episodes

In June this year, an outbreak hit the Indian city of Muzaffarpur in Bihar state, India, killing nearly 200 children, most of them poor rural families. In India, outbreaks of acute neurological diseases with high mortality among children occur annually in Muzaffarpur, the largest Lychee growing region in the country. Bihar, one of Indias poorest states, is usually one of the regions hardest hit by epidemics. In 2011, the encephalitis caused the deaths of 320 children in different northern states. In June 2014, nearly 100 children died in an outbreak of the disease in the region.

To learn more about the subject, the Communication Advisory of the Brazilian Society of Tropical Medicine (BSTM) interviewed Dr. Tapan N. Dhole, from the Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow, India.

Read the full interview:

BSTM: Acute Encephalitis Syndrome (AES) was initially associated with the Japanese Encephalitis Virus (JEV) in the 1970s. Subsequently, other etiologies, especially viral, have been described. Talk about JEV in the recent outbreak that occurred in Bihar state (India).

Dr. Tapan N. Dhole: The recent outbreak that occurred in State of Bihar is primarily Encephalopathy rather than Encephalitis.

Encephalopathy occurred due liver is unable to function properly and large amount of amonia has been generated which effect brain to sudden comatose condition of the patient. In  Encephalitis if infection of virus will produce fever.

Here there is no fever. So there is no infection. This encephalopathy produce constant hypoglycemia because of liver pathway is dearranged.

BSTM: Do you believe lychee toxins may be associated with the outbreak? Why?

Dr. Tapan N. Dhole: The Lychee orchid owner primarily used some insecticide and pesticide to prevent the lychee from insect and ants. Probably these insecticide or pesticide are toxic to the children who are moving in the orchid.  The pesticide or insecticide might metabolise through liver which in turn produce encephalopathy and instant death within couple of hours.Fact remains, the children who has never eaten Lychee also suffered the same attack but as soon rains come all the things will disappear. So it indicate that some toxic powder which contaminate the ground or soil might be responsible.

BSTM: In your opinion, other etiological agents may be involved? Which ones?

Dr. Tapan N. Dhole: Some of the children who are not near to Lychee orchid had suffered from the same clinical attack.

BSTM: In 2017, the first local transmission of Japanese encephalitis was detected in Angola. Is it possible for the virus to be circulating in other countries?

Dr. Tapan N. Dhole: In 2012 probably the same type of transmission had occurred in Polio in Angola where  same Indian strains of polio detected from the 48 Adults .Therefore it is possible for  JE transmission from India to Angola  if they have pigs and Mosquito in their country. There are many Indian who stay in Angola for sugar can industry.

BSTM: Climate change, globalization, and increased population movement levels may provide opportunities for pathogens to expand their geographic area. Do you think it is possible for the virus to reach Brazil? Why? If yes, when?

Dr. Tapan N. Dhole: Yes human movement especially labour class involve in the transmission of diseases, through which it might be possible to reach Brazil in favourable climate and transmission dynamics exists.

BSTM: Would the world be prepared to deal with an outbreak of Japanese encephalitis? Why?

Dr. Tapan N. Dhole: World has not seen yet the outbreak of viral diseases, but I have seen severe outbreak of JE in 2005 in Gorakhpur and Polio outbreak in Lucknow 1992.

BSTM: In addition to improving the surveillance system, increasing awareness of potential risks among health professionals and the population and adopting innovative control strategies, what else is needed to prevent an outbreak?

Dr. Tapan N. Dhole: People are not prepared them solves for these type of problem of outbreak and they always underestimate the burden because adequate tools and techniques are not in place.

BSTM: Arboviruses such as chikungunya, dengue, Japanese and Saint Louis encephalitis, West Nile virus and yellow fever, may provoke cross reactions. So how, is it possible to detect Japanese encephalitis specifically?

Dr. Tapan N. Dhole: All Arboviruses has cross reactivity at antibody level, but there is no cross reactivity at genome level like PCR and sequence, but they are expensive.

BSTM: Could you tell us about your work and the research being conducted by your JEV-related team, such as Increased serum microRNA-29b expression and bad recovery in Japanese encephalitis virus infected patients; A new component to improve the disease recovery?

Dr. Tapan N. Dhole: In our micro RNA paper, WE found that mi R 146a can serve as biomarker in the diseases. But mi R29b was found to be changed significantly in JE patients recovered with neurological sequelae, therefore can serve as a component to improve disease recovery.…