Routine fruit washing to prevent acute toxic encephalopathy
Authors: P A Desingu
Journal: The Lancet Global Health (2017)

I read with great interest the Article by Aakash Shrivastava and colleagues (January, 2017)1Shrivastava A Kumar A Thomas JD et al.Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study.Lancet Glob Health. 2017; 5: e458-e466Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar that reported the association of a 2014 outbreak of acute toxic encephalopathy in Muzaffarpur, India, with lychee (also spelled litchi) consumption using a case-control study. The study reported that lychee consumption 24 h before onset of symptoms was associated with acute toxic encephalopathy in 67 (65%) of 103 cases and 23 (23%) of 102 controls. The same case-control study reported that routinely washing vegetables and fruits was associated with acute toxic encephalopathy in 32 (32%) of 99 cases and 58 (70%) of 83 controls. These results suggest that routinely washing vegetables and fruits might prevent the acute toxic encephalopathy associated with lychee consumption. It suggests that chemicals or other agents on the fruits and vegetables could be associated with acute toxic encephalopathy. This study did not describe the presence of toxins or other agents on the unwashed fruit, only the hypoglycaemic agents inside the fruit. Therefore, detection of toxins inside the fruits might not totally determine lychee's association with acute toxic encephalopathy. Toxins or other agents on the unwashed fruit or vegetables might be associated with the acute toxic encephalopathy outbreak in Muzaffarpur, India, and routine washing of vegetables and fruits might prevent acute toxic encephalopathy. I declare no competing interests. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control studyOur investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks. Full-Text PDF Open AccessRoutine fruit washing to prevent acute toxic encephalopathy – Authors' replyP A Desingu points out our investigation finding that routinely washing vegetables and fruits could be protective against acute toxic encephalopathy1 and suggests that this indicates that an exogenous toxin or agent in unwashed fruits or vegetables, rather than the naturally occurring toxins hypoglycin A and methylenecyclopropylglycine (MCPG) found in lychees, might be associated with the recurring epidemic toxic encephalopathy in Muzaffarpur. We considered this possibility, and tested extensively for evidence of exogenous agents, such as pesticides and herbicides, in the biological specimens of affected children as well as in fruits, vegetables, and grains collected from affected villages; these results were all consistently negative. Full-Text PDF Open Access