Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam

Nga Thi Phan (1) , Meriadeg M. Ar Gouilh (2, 3) , Juliette Paireau (4) , Loan Phuong (1) , Justine J. Cheval (5) , Nghia Duy Ngu (1) , Charles Hébert (6) , Tuan Hai Ngu (1) , Olivier Lortholary (7) , Laura Tondeur (4) , Jean-Claude Manuguerra (8) , Robert Barouki (9) , Johannes Sander (10) , Nils Janzen (10) , Hien Tran Nguyen (1) , Paul Brey (11) , Arnaud Fontanet (12, 4) , Marc Eloit (13)

1 NIHE - National Institute of Hygiene and Epidemiology [Hanoi, Vietnam]
2 GRAM 2.0 - Groupe de Recherche sur l'Adaptation Microbienne
3 CIBU - Cellule d'Intervention Biologique d'Urgence - Laboratory for Urgent Response to Biological Threats
4 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
5 PathoQuest
6 REG - Régulation de l'expression génétique
7 Centre d'infectiologie Necker-Pasteur [CHU Necker]
8 ERI - Environnement et Risques infectieux - Environment and Infectious Risks
9 T3S - UMR_S 1124 - Toxicité environnementale, cibles thérapeutiques, signalisation cellulaire
10 MHH - Hannover Medical School [Hannover]
11 Institut Pasteur du Laos
12 CNAM - Conservatoire National des Arts et Métiers [CNAM]
13 Découverte de Pathogènes - Pathogen Discovery

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.

Keywords: viruses; hypoglycins; litchi; enteroviruses; methylenecyclopropylglycine; outbreaks; litchi cultivation; hypoglycemic toxins; hypoglycemia; acute encephalitis-like syndrome; children; encephalitis; acute encephalitis syndrome; Vietnam; Bac Giang Province; meningitis/encephalitis

Domains: Life Sciences [q-bio]; Santé publique et épidémiologie; Environmental Sciences; Global Changes; Life Sciences [q-bio]; Biodiversity; Systematics, Phylogenetics and taxonomy; Life Sciences [q-bio]; Human health and pathology; Emerging diseases; Life Sciences [q-bio]; Human health and pathology; Infectious diseases; Life Sciences [q-bio]; Microbiology and Parasitology; Virology; Life Sciences [q-bio]; Toxicology; Ecotoxicology

Nga Thi Phan, Meriadeg M. Ar Gouilh, Juliette Paireau, Loan Phuong, Justine J. Cheval, et al.. Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerging Infectious Diseases, 2018, 24 (8), pp.1435-1443. ⟨10.3201/eid2408.171004⟩. ⟨hal-02146362⟩