Key result
Children with acute encephalitis-like syndrome positive for hypoglycemic toxins had higher rates of hypoglycemia and seizures than those with enterovirus.
Observational (n=58)
No
Seasonal outbreaks of acute encephalitis-like syndrome in children during litchi harvests in Vietnam are likely caused by hypoglycemic toxins rather than viral encephalitis.
Answers are grounded in this paper and cite their sources.
May warrant toxin evaluation in seasonal pediatric cases; hypothesis-generating for toxin over enterovirus etiology but needs confirmation.
We investigated the cause of seasonal outbreaks of pediatric acute encephalitis-like syndrome associated with litchi harvests (May-July) in northern Vietnam since 2008. Nineteen cerebrospinal fluid samples were positive for human enterovirus B, and 8 blood samples were positive for hypoglycemic toxins present in litchi fruits. Patients who were positive for hypoglycemic toxins had shorter median times between disease onset and admission, more reports of seizures, more reports of hypoglycemia (glucose level <3 mmol/L), lower median numbers of leukocytes in cerebrospinal fluid, and higher median serum levels of alanine aminotransferase and aspartate transaminase than did patients who were positive for enteroviruses. We suggest that children with rapidly progressing acute encephalitis-like syndrome at the time of the litchi harvest have intoxication caused by hypoglycemic toxins, rather than viral encephalitis, as previously suspected. These children should be urgently treated for life-threatening hypoglycemia.
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Nga et al. (2018) conducted an observational in Acute encephalitis-like syndrome (n=58). Hypoglycemic toxins (HGA/MCPG) vs. Enterovirus infection was evaluated on Hypoglycemia (glucose level <3 mmol/L) (p=0.001). Children with acute encephalitis-like syndrome positive for hypoglycemic toxins had higher rates of hypoglycemia and seizures than those with enterovirus.
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