Editing Lychee (section)

== Poisoning ==
In 1962, it was found that lychee seeds contained [[Methylene cyclopropyl acetic acid|methylenecyclopropylglycine]] (MCPG), a [[homology (biology)|homologue]] of [[hypoglycin A]], which caused [[hypoglycemia]] in human and animal studies.<ref>{{Cite journal
| pmid = 13901296
| year = 1962
| last1 = Gray
| first1 = D. O.
| title = Alpha-(Methylenecyclopropyl)glycine from Litchi seeds
| journal = The Biochemical Journal
| volume = 82
| issue = 3
| pages = 385–9
| last2 = Fowden
| first2 = L
| pmc = 1243468
| doi=10.1042/bj0820385
}}</ref>
Since the end of the 1990s, unexplained outbreaks of [[encephalopathy]] had been documented, appearing to affect only children in India<ref>{{cite news|url=http://timesofindia.indiatimes.com/city/kolkata/Litchi-virus-kills-8-kids-in-Malda/articleshow/36225598.cms|title=Litchi virus kills 8 kids in Malda|newspaper=Times of India|date=8 June 2014|access-date=12 June 2014}}</ref> (where it is called ''chamki bukhar''),<ref>{{cite news |author=Agence France-Presse |title=At least 31 children in India killed by toxin in lychees |url=https://www.theguardian.com/world/2019/jun/13/at-least-31-children-in-india-killed-by-toxin-in-lychees |access-date=13 June 2019 |work=The Guardian |date=13 June 2019}}</ref> and northern [[Vietnam]] (where it was called Ac Mong encephalitis after the Vietnamese word for [[nightmare]], {{lang|vi|ác mộng}})<ref name="paireua" /> during the lychee harvest season from May to June<ref>{{cite web|url=http://www.fao.org/docrep/005/ac684e/ac684e08.htm|title=Lychee production in India|vauthors=Singh HP, Babita S |publisher=Food and Agricultural Organization of the UN|access-date=12 June 2014}}</ref> or July.<ref name="paireua">{{Cite journal
 | pmid = 23092599
| year = 2012
| last1 = Paireau
| first1 = J
| title = Litchi-associated acute encephalitis in children, Northern Vietnam, 2004-2009
| journal = Emerging Infectious Diseases
| volume = 18
| issue = 11
| pages = 1817–24
| last2 = Tuan
| first2 = N. H.
| last3 = Lefrançois
| first3 = R
| last4 = Buckwalter
| first4 = M. R.
| last5 = Nghia
| first5 = N. D.
| last6 = Hien
| first6 = N. T.
| last7 = Lortholary
| first7 = O
| last8 = Poirée
| first8 = S
| last9 = Manuguerra
| first9 = J. C.
| last10 = Gessain
| first10 = A
| last11 = Albert
| first11 = M. L.
| last12 = Brey
| first12 = P. T.
| last13 = Nga
| first13 = P. T.
| last14 = Fontanet
| first14 = A
| doi = 10.3201/eid1811.111761
| pmc = 3559149
}}</ref>

A 2013 investigation by the U.S. [[Centers for Disease Control and Prevention]] (CDC), in India, showed that cases were linked to the consumption of lychee fruit,<ref name=CDC>{{cite journal|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6403a1.htm|title=Outbreaks of Unexplained Neurologic Illness — Muzaffarpur, India, 2013–2014|journal= MMWR. Morbidity and Mortality Weekly Report|volume=64|issue=3|pages=49–53 |vauthors=Shrivastava A, et al. |date=30 January 2015|access-date=30 Jan 2015|pmid=25632950 |pmc=4584556}}</ref> causing a noninflammatory [[encephalopathy]] that mimicked symptoms of [[Jamaican vomiting sickness]].<ref name=nyt/> Because low blood sugar ([[hypoglycemia]]) of less than 70&nbsp;mg/dL in the [[undernourished]] children on admission was common, and associated with a poorer outcome (44% of all cases were fatal) the CDC identified the illness as a [[Hypoglycemia|hypoglycemic]] encephalopathy.<ref name=CDC />

The investigation linked the illness to hypoglycin A and MCPG toxicity, and to [[malnutrition|malnourished]] children eating lychees (particularly unripe ones) on an empty stomach.<ref name=lancet2/>

The CDC report recommended that parents ensure their children limit lychee consumption and have an evening meal, elevating blood glucose levels that may be sufficient to deter illness.<ref name=CDC/><ref name="nyt">{{cite news|url=https://nytimes.com/2017/01/31/world/asia/lychee-litchi-india-outbreak.html|title=Dangerous Fruit: Mystery of Deadly Outbreaks in India Is Solved|author=Barry, Ellen|newspaper=New York Times|date=31 January 2017|access-date=1 February 2017}}</ref> Education campaigns aimed at reducing the prevalence of lychee-associated encephalopathy have been launched, some before the mechanism of toxicity was elucidated, for example beginning in 1995 in China.<ref name="ZhangFontaine2017">{{cite journal |last1=Zhang |first1=Li Jie |last2=Fontaine |first2=Robert E |title=Lychee-associated encephalopathy in China and its reduction since 2000 |journal=The Lancet Global Health |date=September 2017 |volume=5 |issue=9 |pages=e865 |doi=10.1016/S2214-109X(17)30291-7 |pmid=28807180 |doi-access=free }}</ref>

Earlier studies had incorrectly concluded that transmission may occur from direct contact with lychees contaminated by [[bat]] [[saliva]], urine, or [[guano]] or with other [[vector (epidemiology)|vectors]], such as insects found in lychee trees or [[sand flies]], as in the case of [[Chandipura virus]].<ref name="paireua"/> A 2017 study found that pesticides used in the plantations could be responsible for the encephalitis and deaths of young children in [[Bangladesh]].<ref>{{cite web|url=https://www.voanews.com/a/pesticides-lychee-south-asian-children-sudden-deaths/3958831.html|title=Pesticides May Have Caused South Asian Children's Sudden Deaths|publisher=Voa news|date=25 July 2017|access-date=28 July 2017}}</ref><ref>{{Cite journal
| year = 2017
| author1 = Mohammed Saiful Islam
| title = Outbreak of Sudden Death with Acute Encephalitis Syndrome Among Children Associated with Exposure to Lychee Orchards in Northern Bangladesh, 2012
| journal =  The American Journal of Tropical Medicine and Hygiene
| doi=10.4269/ajtmh.16-0856
| pmid = 28749763
| volume=97
| issue = 3
| pages=949–957
| pmc = 5590581
}}</ref>