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Acute HME syndrome


In many districts of western Uttar Pradesh, Uttarakhand, Odisha 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.

A six-member panel led by virologist Dr Jacob John from Vellore's Christian Medical College & Hospital was constituted by the Odisha state government to investigate into the death of approximately 100 children in Malkangiri district that occurred since September 2015. The deaths were suspected to have occurred due to Japanese encephalitis. In its interim report, the panel indicated that anthraquinone, a toxin found in the ‘bada chakunda’ (Cassia occidentalis) plant was identified in the urine sample of 5 deceased children thus indicating that some of the children may have died of Encephalopathy, which is caused due to consumption of the plant.


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