Outbreaks of unexplained XXXX - muzaffarpur, India, 2013-2014.

@entity1 @entity69265 @entity198 @entity11722 @entity283 @entity75 @entity16 @entity4053 @entity413
Outbreaks of an unexplained acute @entity16 affecting young @entity1 and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious @entity198 and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory @entity75 , possibly caused by a toxin. A common laboratory finding was low blood @entity413 (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic @entity75 and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for @entity69265 ( @entity11722 ), a compound found in litchi seeds known to cause @entity4053 in animal studies. Current @entity283 recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of @entity4053 in ill @entity1 .
