Acute HME syndrome

Ripe pods of Cassia occidentalis plant

In many districts of western Uttar Pradesh, Uttarakhand and Haryana, India, outbreaks of an acute “encephalopathy” syndrome dubbed as a “mysterious disease” have been an annual feature for many years. The disease affects rural young children during the winter months of September to December, and carries case fatality rates of around 75-80%. Most investigators assume it to be viral “encephalitis”. According to a rough estimate, at least 500-700 young previously healthy children have been losing their lives every year for many years in this region. Many national investigating agencies failed to diagnose the entity despite investigating for many consecutive years.

A team of investigators led by a local pediatrician based in Bijnor district, investigated this epidemic in Bijnor, one of the affected districts of western Uttar Pradesh and published their findings as three papers in national peer-reviewed journals. At the end of four years, it was concluded that the disease was not encephalitis as so far believed but a fatal multi-system disease affecting liver, muscle and brain called, “acute hepatomyoencephalopathy (HME) syndrome” induced by a phytotoxin. Later, the epidemiological investigations showed that it was due to consumption of beans of a ubiquitous herb called Cassia occidentalis by the poor, unsupervised children of the area responsible for the development of this syndrome.

The syndrome[1]

The acute severe Cassia occidentalis poisoning in children affects multiple systems. Functional and biochemical evidences to show toxic effect on the brain, liver and striated muscles. Pathologically there is acute onset massive zonal necrosis of liver and histopathology evidence of acute muscle fibre degeneration. The degenerative changes in the brain are mild, but brain oedema is severe and is believed to be the immediate cause of death.[2]

References

  1. ↑ "Clinical & pathological features of acute toxicity due to Cassia occidentalis in vertebrates" (PDF). ICMR web site. Indian Journal of Medical Research. July 2009. Retrieved October 21, 2015.
  2. ↑ Vashishtha, Vipin M. (July 2009). "Clinical & pathological features of acute toxicity due to Cassia occidentalis in vertebrates" (PDF). Indian Journal of Medical Research. Retrieved October 18, 2015.

Further reading

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