Lychee-associated encephalopathy in China and its reduction since 2000
Authors: Li Jie Zhang, Robert E Fontaine
Journal: The Lancet Global Health (2017)

We commend Aakash Shrivastava and colleagues (April, 2017)1Shrivastava A Kumar A Thomas JD et al.Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffapur, India 2014: a case control study.Lancet Glob Health. 2017; 5: e458-e466Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar on their meticulous epidemiological and toxicological investigation, which attributed severe encephalopathy in Indian children to methyl cyclopropyl glycine from lychees (also spelled litchis).1Shrivastava A Kumar A Thomas JD et al.Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffapur, India 2014: a case control study.Lancet Glob Health. 2017; 5: e458-e466Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar Lychees are widely cultivated and well renowned in China. Cautionary messages about the dangers of binging on lychees abound from ancient folklore to the modern electronic media, but these accounts are vague about the disease it causes. Accordingly, we searched the Chinese medical literature from 1960 to 2017, and identified 11 publications reporting 247 cases (11% fatal) of CNS disease that developed after eating lychees.2Liu Y Clinical characteristics analysis of 71 Litchi disease patients.Guangxi Med J. 2000; 22 (in Chinese).: 1038-1039Google Scholar, 3Huang L Ye G Clinical characteristics analysis of 44 Litchi disease patients.J Clin Ped. 1991; 9 (in Chinese).: 42-43Google Scholar, 4County prevention and treatment team for Litchi disease. Saving 22 severe "Litchi disease" patients.Hainan Med. 1976; (in Chinese).: 10-16Google Scholar, 5Wu J Clinical characterisitic analysis of 17 hypoglycemia patients resulted from eating too much Litchi.Guangdong Hyg. 1996; 17 (in Chinese).: 323-324Google Scholar, 6Yang G Huang M Liu F Wei Y Clinical characteristics analysis of 17 Litchi disease patients.Guangxi Hygiene. 1979; (in Chinese).: 28-29Google Scholar, 7Wu D Experience of Litchi disease prevention and control.Hainan Med. 1981; (in Chinese).: 21Google Scholar, 8Pan J Weng H Liu Y et al.Diagnosis and prevention of Litchi disease among children.Journal of Applied Clinical Pediatrics. 1992; 7 (in Chinese).: 203Google Scholar, 9Zhu G Three litchi disease patient reports.Sichuan Med J. 1982; 3 (in Chinese).: 179Google Scholar, 10Huang L Ye G A fatal Litchi disease patient report.Fujian Med J. 1993; 15 (in Chinese).: 71Google Scholar, 11Meng Q One Litchi disease patient report.Hebei Medicine. 2001; 7 (in Chinese).: 960-961Google Scholar, 12Xu L Lin Z Cheng F et al.Emergency treatment analysis for 48 Litchi poisoning patients.Fujian Med J. 2015; 37 (in Chinese).: 50-51Google Scholar The clinical and epidemiological features mirror the Indian experience. Children aged between 1 and 9 years accounted for 77% of cases. Patients had rapid onset (<1 h) of convulsions or unconsciousness, 85% between 0300 and 0900 h, and hypoglycaemia plus mild prodromal symptoms (table). All had eaten lychees within 24 h of disease onset, often in 300 g to 1 kg amounts for 2–10 consecutive days. All but one patient lived in lychee-producing, southern provinces.TableFindings reported for 247 cases of lychee-associated CNS disease in China, from 1976 to 2015Cases (n=247)*Unless otherwise notedPercentageBlood glucose <3·9 mmol/L†Based on 179 patients who had their blood glucose determined (range: 0–4·17 mmol/L)17598%Convulsion or coma19880%Convulsion18977%Coma16968%Diaphoresis16768%Weakness14659%Cold clammy limbs14559%Lethargy12049%Fever‡Temperature ranged from 38–40°C for 57 patients with reported fever8233%Pallor6828%Slow reaction to stimuli4619%Mild diarrhoea3213%Vomiting2912%Facial cyanosis2912%Screaming137%* Unless otherwise noted† Based on 179 patients who had their blood glucose determined (range: 0–4·17 mmol/L)‡ Temperature ranged from 38–40°C for 57 patients with reported fever Open table in a new tab Beginning in 1995, the Chinese print media and local educational campaigns warning the public of the dangers of lychees increased in lychee-producing counties. Nowadays, the internet has supplanted the print media. A search for "lychee disease" in Chinese yielded more than 100 000 hits. Since 2000, only one paediatric case of lychee disease has been reported (in 2001). Of the 48 adult cases of lychee disease reported since 2000, all except one occurred in 2015.12Xu L Lin Z Cheng F et al.Emergency treatment analysis for 48 Litchi poisoning patients.Fujian Med J. 2015; 37 (in Chinese).: 50-51Google Scholar All 48 patients received emergency treatment with 50% glucose, and 47 survived. Other lychee-producing countries might also benefit from public information, education, and simple medical intervention. We 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 Access