Sanjeev Kumar Patro

Bhubaneswar: Like the Bihar health mandarins, the new Odisha health minister Naba  Kishore Das seems to be in denial mode that Acute Encephalitis Syndrome (AES) is a reality in Odisha, notwithstanding the bitter reality of Odisha's brush with the killer disease in 2016.

In a statement to the media yesterday, the State Health Minister had categorically stated that Odisha has not witnessed a single case of AES in 2019.

The reality, however, is the State had not only witnessed a whopping 462 AES cases for the first four months (January - April) of 2019, it also had topped the country in AES during the period, revealed the NVBDCP data. The data further showed that Odisha had recorded almost 36 cases of Japanese Encephalitis (JE).

But the good riddance for Odisha is, the State had not recorded a single  case of fatality due to AES/JE during the period of Jan-Apr 2019. However, the caveat is AES/JE cases spiral up during May to September. Therefore, the risk still lurks around.

However, the situation is not all that hunky and dory. Odisha had recorded a total of 1,096 AES cases in 2016, which then was boiled down to around 91 cases per month.

Now contrast it with the 2019 data. The first four months saw 462 cases or at the rate of over 115 per month. The acuteness is clearly discernible, though the peak season has only started from May. And May-June data is under processing, informed the NVBDCP Odisha wing here.

There is no denying the fact that Odisha's fight against the killer AES/JE post the 2016 horror-show appears to be good.

The fatality, which had jumped to a high of 157 (AES -115, JE - 42) in 2016 from a mere 4 in 2015, had dropped to 15 in 2017 and 10 in 2018 respectively. The first four months of 2019 had not reported any mortality, but the reality is the peak season has now only started.

In the given context, the health minister Naba Das' statement regarding non-surfacing of a single AES case in Odisha appears baffling, and the minister's diktat to go for lab test of litchi fruits ridiculous.

Consider the litchi truth. The delectable fruit does contain a toxin called methylenecyclopropylglycine. The first research that linked Litchis with AES/JE that was done by Dr Jacob John, who was assigned the task to find the cause of AES/JE spurt in Malkangiri by the Odisha government in 2016.

A look at Dr John's study paper, what is clearly discernible is he mentioned that toxins in litchi are only a trigger factor of AES/JE in a malnourished population. The inference is malnourishment is the culprit not toxins of litchi.

So the health minister's diktat of putting the humble fruit under scrutiny is uncalled for.

Moreover, as per a senior scientist of Regional Medical Research Centre (RMRC) here, if litchi toxins are responsible for child deaths, then the disease could be Acute Hepatomyo Encephalopthy syndrome (AHE), not AES.

Why AHE? The word Hepatomyo hints at liver (liver is also known as hepatic gland in medical terminology). The litchi toxin, as per Dr Jacob John, causes Hypoglycemia. Hypoglycemia means low level of glucose in blood.

As malnourishment leads to low blood glucose, the glycogen (excess glucose) stored in liver sees a depletion. So, when there is no or reduced glycogen reserve, the glycogen starts breaking into glucose. Further fall, leads to burning of fats. As glucose levels are low, the liver witness ketogenesis or say produce ketones, which are neurotoxins.

As the entire description links the neurotoxins to improper liver functioning, therefore, medical science has termed the disease as AHE. Therefore, AES and AHE need differential treatment.

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