More than 150 children have died in eastern India from a “brain fever” believed to be linked to a toxic substance found in lychee fruit, officials said.

Health officials said Monday that at least 152 children have died from acute encephalitis syndrome in the country’s Bihar state, Agence France-Presse reported.

The deadly disease causes glucose levels to plummet and brain inflammation mostly in malnourished children under the age of 10, according to experts.

Experts haven’t pinpointed the exact cause of the syndrome but believe it may be from a toxin in unripe lychees, which are grown widely in the Muzaffarpur district, the center of the outbreak.

The country’s highest court has ordered an investigation into the deadly outbreak, as well as a report on “medical facilities, nutrition, sanitation and hygiene conditions” in Bihar state, according to AFP.

More than 1,350 children have died from the disease in the past decade, including a record 355 in 2014, officials said.

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