TY - JOUR AU - Phan, Nga Thi AU - Gouilh, Meriadeg Ar AU - Paireau, Juliette AU - Phuong, Loan AU - Cheval, Justine AU - Ngu, Nghia Duy AU - Hébert, Charles AU - Nguyen, Tuan Hai AU - Lortholary, Olivier AU - Tondeur, Laura AU - Manuguerra, Jean-Claude AU - Barouki, Robert AU - Sander, Johannes AU - Janzen, Nils AU - Nguyen, Hien Tran AU - Brey, Paul AU - Fontanet, Arnaud AU - Eloit, Marc T1 - Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam T2 - Emerging Infectious Disease journal PY - 2018 VL - 24 IS - 8 SP - 1435 SN - 1080-6059 AB - 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. KW - hypoglycemic toxins KW - enteroviruses KW - viruses KW - meningitis/encephalitis KW - encephalitis KW - acute encephalitis syndrome KW - acute encephalitis-like syndrome KW - outbreaks KW - children KW - hypoglycins KW - litchi KW - methylenecyclopropylglycine KW - Bac Giang Province KW - northern Vietnam KW - hypoglycemia KW - litchi cultivation KW - Vietnam DO - 10.3201/eid2408.171004 UR - https://wwwnc.cdc.gov/eid/article/24/8/17-1004_article ER - End of Reference