But a team of American and Indian scientists say they have found the cause of the mystery illness, which killed more than 100 children a year: eating unripe lychees on an empty stomach.
The mysterious deaths appear to have been caused by poor children eating fallen fruit from the ground in the lychee orchards of India's main producing region, Bihar. This mystery had puzzled the entire, worldwide medical community for some time, but US Centers for Disease Control and Prevention as well as India's National Centre for Disease Control worked together and were able to identify the litchi as the culprit.
Experiments by experts showed that Lychees contain a specific kind of toxin that restrains the body's ability to produce glucose. Children who usually fell ill skipped dinner and ate the lychee on an empty stomach, which would lead to hypoglycemia. But some of the affected children had strikingly low levels, and those with low blood glucose were twice as likely to die, Dr Srikantiah said.
Scientists also looked for other non-infectious causes, like presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. According to the parents, their children would often spend the day eating lychee fruit in the local orchards and not make it home in time for an evening meal. It has been found that litchi contains certain natural toxins, mainly said to be in the seeds.
The study recommends that to prevent the illness and improve chances of survival, litchi consumption needs to be minimized and an evening meal should be ensured. But most of these children had consumed lychee fruit shortly before becoming ill.
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In 2015, as a result of the investigation, health officials began urging parents in the area to be sure to feed young children an evening meal and to limit their consumption of lychees.
If you are suffering from low blood sugar symptoms then there are many things around you that a person must be aware of. Since this has come into place, the number of cases has been dramatically cut from hundreds per year to 50.
The amino acid is also found in other fruits of the same family like rambutan, longan and ackee.
An outbreak of a similar acute neurological illness with hypoglycaemia and seizures was reported in June 2014, among young children in Malda, a litchi cultivation district in West Bengal.
The researchers said they believe their study may help shed light on similar outbreaks in lychee-growing regions in Bangladesh and Vietnam, although thorough investigations in those areas are yet to be done.