DOCSLIB.ORG

Persistence of Tropical Ataxic Neuropathy in a Nigerian Community

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Persistence of Tropical Ataxic Neuropathy in a Nigerian Community 96 J Neurol Neurosurg Psychiatry 2000;69:96–101 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.69.1.96 on 1 July 2000. Downloaded from Persistence of tropical ataxic neuropathy in a Nigerian community O S A Oluwole, A O Onabolu, Hans Link, Hans Rosling Abstract as TAN diVer widely in clinical presentation, Objectives—The term tropical ataxic neu- natural history, and response to treatment. Two ropathy (TAN) is currently used to de- of the neurological syndromes grouped as scribe several neurological syndromes tropical ataxic neuropathy were described in attributed to toxiconutritional causes. Nigeria in the past 60 years. However, TAN was initially proposed to In 1930, a syndrome that aVected predomi- describe a specific neurological syndrome nantly adolescent school pupils in several seen predominantly among the Ijebu boarding schools was reported from some com- speaking Yorubas in south western Ni- munities in eastern and western parts of geria. In this study, the prevalence of TAN Nigeria.6–8 The main clinical features were sore was determined in Ososa, a semiurban tongue, angular stomatitis, and skin desquama- community in south western Nigeria de- tions followed by optic atrophy in a large scribed as endemic for TAN in 1969, and proportion of cases. Recovery of the lesions its neurological features were compared occurred during holidays, but many aVected with Strachan’s syndrome, prisoners of pupils had a recurrence on returning to school.9 war neuropathy, the epidemic neuropathy The school diet, dominated by cassava food in Cuba, and konzo. products, was implicated as causal and almost Methods—A census of Ososa was followed 100% of the patients responded to improvement by door to door screening of all subjects of diet and supplements with autoclaved dried aged 10 years and above with a newly yeast.9 The second syndrome, unlike the syn- designed screening instrument. Subjects drome of the 1930s, aVected middle aged and who screened positive had a neurological elderly people predominantly and its geographi- examination, and the diagnosis of TAN was made if any two or more of bilateral cal distribution was limited to some communi- ties in south western Nigeria.410It was variously optic atrophy, bilateral neurosensory 4 deafness, sensory gait ataxia, or distal named endemic neuropathy degenerative neuropathy,11 tropical nutrition neuropathy,12 symmetric sensory polyneuropathy were 13 present. and tropical ataxic neuropathy. DiVerent com- Neurology Unit, Results—A total of 4583 inhabitants were binations of sensory polyneuropathy, bilateral Department of registered in the census. Of these, 3428 optic atrophy, bilateral neurosensory deafness, Medicine, University 413 of Ibadan, Nigeria subjects aged 10 years and above were and sensory gait ataxia were found. Its causa- http://jnnp.bmj.com/ O S A Oluwole screened. The diagnosis of TAN was made tion was attributed to dietary cyanide from the 13–15 in 206 of 323 subjects who screened monotonous consumption of foods proc- International Institute positive for TAN. The prevalence of TAN essed from the starchy roots of cassava (Manihot for Tropical esculenta esculenta).16 In contradistinction to the Agriculture, Ibadan, was 6.0%, 3.9% in males and 7.7% in Nigeria females. The highest age specific preva- first syndrome, cases did not respond to O S A Oluwole lence was 24% in the 60–69 years age group improvement in diet or vitamin supplementa- A O Onabolu in women. tion.17 18 Conclusion—The occurrence of TAN in In the 1980s, the occurrence of TAN was on September 26, 2021 by guest. Protected copyright. Division of Ososa continues at a higher prevalence reported to have subsided because cases were International Health, IHCAR, Department than was reported 30 years ago. Its neuro- no longer registered in the teaching hospitals. It of Public Health logical features and natural history do not was speculated that improvement in diet, Sciences, Karolinska resemble those described for Strachan which followed the oil boom economic recov- Institute, SE-171 76 syndrome, epidemic neuropathy in Cuba, ery period of the 1970s in Nigeria, caused the Stockholm, Sweden or konzo. The increasing consumption of disappearance of the syndrome.19 However, a O S A Oluwole A O Onabolu cassava foods linked to its causation makes recent food survey in Ososa (fig 1), a H Rosling TAN of public health importance in Ni- semiurban community of Ijebu speaking Yoru- geria, the most populous African country. bas in south western Nigeria previously sur- Division of Neurology, (J Neurol Neurosurg Psychiatry 2000;69:96–101) veyed for TAN in 1969,11 showed that about Huddinge Hospital, 80% of the population consumed foods Karolinska Institute, Keywords: tropical myeloneuropathy; nutritional processed from the starchy roots of cassava Sweden polyneuropathy; ataxia 20 H Link thrice daily. The possibility that TAN may still be occurring in this community motivated Correspondence to: Several neurological syndromes described this study. Dr O S A Oluwole [email protected] from diVerent tropical regions in the past The aim of this study was to determine the century1–4 have been classified as tropical prevalence of TAN in Ososa, and to compare Received 15 July 1999 and in myeloneuropathies and further grouped into its neurological features with those described revised form 1 29 December 1999 tropical ataxic neuropathy (TAN) and tropical for Strachan’s syndrome, prisoner of war Accepted 9 February 2000 spastic paraparesis.5 The syndromes grouped neuropathy,2 epidemic neuropathy of Cuba,21 Persistence of tropical ataxic neuropathy in a Nigerian community 97 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.69.1.96 on 1 July 2000. Downloaded from bination of the questionnaire and the tandem walk test. Only subjects 10 years of age and above were screened as previous reports showed TAN to be rare below the age of 10 years.10 15 Subjects who screened positive from either the questionnaire or the tandem walk Abuja test were invited for neurological examination • at the local health centre in Ososa. • Ibadan HISTORY AND EXAMINATION Ososa • Ijebu-Ode In two of the seven quarters in Ososa, Lagos• Idomowo, and Odolakoye, all subjects who screened positive had a detailed history taken, and a clinical and neurological examination, and those diagnosed with TAN had their urine Figure 1 Map of Nigeria showing Ososa in relation to some major towns. tested for sugar and protein. These two quarters were purposely sampled to represent and konzo, which is also attributed to exposure the known socioeconomic variations among all to dietary cyanide.22 quarters. In depth interviews to determine the history of illness and exposure to industrial chemicals, drugs, and pesticides were carried Subjects and methods out. Detailed neurological examination with STUDY SITE standard methods assessed higher cerebral Ososa is a semiurban community in the Odog- functions, cranial nerves, motor system, coor- bolu local government area of Ogun State, dination, gait, and somatosensory modalities of Nigeria, where TAN was endemic in the 24 25 11 pain, touch, joint position, and vibration. In 1960s. This community, divided into seven the remaining five quarters subjects who administrative quarters from historical ante- screened positive had an abbreviated neuro- cedents, has an indigenous population of logical examination more focused on specific Ijebus, an ethnic group of the Yoruba tribe. All modalities required for the diagnosis of TAN. houses in the town are cement faced but vary widely in size and quality. Small scale cassava farming is the source of livelihood of most of DIAGNOSIS The diagnosis of TAN was made when any two the population. Social amenities such as or more of bilateral optical atrophy, bilateral electricity, water, good road networks, and neurosensory deafness, distal symmetric sen- motor transport are within access of all inhab- sory polyneuropathy, or sensory gait ataxia itants. were present as defined in previous studies.10 13 15 The diagnostic criteria were CENSUS defined as follows: optic atrophy required All houses in Ososa were numbered, and every distinct pallor of at least half of the disc; neuro- member of each household had their names, sensory deafness required impairment of http://jnnp.bmj.com/ ages, and sex recorded. Subjects without birth Rinne’s test; sensory polyneuropathy required records had their ages estimated to the nearest impairment of pin prick at a level above the 5 years through comparison with peers whose malleoli and wrist on both extensor and flexor ages were known and belong to the same “age surfaces; and gait ataxia required impairment group society” peculiar to the local culture. of tandem walk. SCREENING CONSENT A screening questionnaire with items to assess on September 26, 2021 by guest. Protected copyright. Consent for this study was obtained from the visual, auditory, motor, gait, and somatosen- local government health authority, the mon- sory symptoms consistent with the clinical arch (Oba) of Ososa, chiefs of the quarters, and neurology of TAN as previously described in heads of families. studies from Nigeria23 was developed. The questionnaire was prepared in the English lan- guage and translated to the local language, Results Yoruba, by two independent translators, who EPIDEMIOLOGY subsequently agreed on consensus translation. A total of 4583 inhabitants was registered in The consensus translation was translated back the census. Of these, 3428 subjects aged 10 into English to check for accuracy before final years and above were screened and 323 were translation to the Yoruba language. The positive for TAN. Sixty six patients screened questionnaire was tested and piloted on 10 positive on all the five items of the screening subjects and then revised. The tandem walk instrument, 94 on all items of the questionnaire examination was added as a clinical test to only, and 15 on tandem walk test only. The improve the sensitivity of the questionnaire. remaining 148 were positive on various combi- The tandem walk test was standardised by nations of the questionnaire items and the tan- making the subjects walk heel to toe in a dem walk test.
Load more

Recommended publications
  • Global and Local Health – Legacy of Hans Rosling
    Seminar Global and Local Health – Legacy of Hans Rosling When: 26th October, 2017. 9.00 – 13.00. Where: Jacob Berzelius, Berzelius väg 3 Please register for the event here: https://sv.surveymonkey.com/r/PC3JR9Z In 2006, Hans Rosling presented his TED talk, which made him known internationally and changed the way we look at the world. However, long before that Hans Rosling had discovered a disease related to Cassava toxicity. It is an interesting story of a researcher who went to Mozambique to work as a health worker. Hans Rosling and his wife had traveled from Sweden to Mozambique. He had studied medicine and public health. In mid-1981, a disease appeared in the province of Nampula, north of Mozambique causing paralysis, with blurred vision and difficulty speaking. Soon over 1,000 cases were reported. The condition was called Konzo, which, in the Yaka language (spoken in a village of southeastern Democratic Republic of the Congo) means “tied legs.” Cassava is the third most important food crop in the tropics, after rice and maize. Esteemed by smallholder farmers for its tolerance to drought and infertile soils, the crop is inherently eco-efficient, offering a reliable source of food and income. Half a billion people in Africa eat cassava every day, and this high-starch root is also an important staple in Latin America and the Caribbean. The seminar “Global and Local Health – Legacy of Hans Rosling will discuss the disease Konzo in the context of research carried out by Hans Rosling. The seminar is a collaboration between Swedish Agriculture University, Uppsala (SLU – Global) and Centre for global health, Karolinska Institutet.
    [Show full text]
  • Research on Motor Neuron Diseases Konzo and Neurolathyrism: Trends from 1990 to 2010
    Research on Motor Neuron Diseases Konzo and Neurolathyrism: Trends from 1990 to 2010 Delphin Diasolua Ngudi1,2, Yu-Haey Kuo2, Marc Van Montagu2, Fernand Lambein2* 1 Programme National de Nutrition (PRONANUT), Kinshasa, Democratic Republic of the Congo, 2 Institute of Plant Biotechnology Outreach (IPBO), Ghent University, Ghent, Belgium Abstract Konzo (caused by consumption of improperly processed cassava, Manihot esculenta) and neurolathyrism (caused by prolonged overconsumption of grass pea, Lathyrus sativus) are two distinct non-infectious upper motor neurone diseases with identical clinical symptoms of spastic paraparesis of the legs. They affect many thousands of people among the poor in the remote rural areas in the central and southern parts of Africa afflicting them with konzo in Ethiopia and in the Indian sub-continent with neurolathyrism. Both diseases are toxico-nutritional problems due to monotonous consumption of starchy cassava roots or protein-rich grass pea seeds as a staple, especially during drought and famine periods. Both foods contain toxic metabolites (cyanogenic glycosides in cassava and the neuro-excitatory amino acid b-ODAP in grass pea) that are blamed for theses diseases. The etiology is also linked to the deficiency in the essential sulfur amino acids that protect against oxidative stress. The two diseases are not considered reportable by the World Health Organization (WHO) and only estimated numbers can be found. This paper analyzes research performance and determines scientific interest in konzo and neurolathyrism. A literature search of over 21 years (from 1990 to 2010) shows that in terms of scientific publications there is little interest in these neglected motorneurone diseases konzo and neurolathyrism that paralyze the legs.
    [Show full text]
  • Similarities Between Tropical Spastic Paraparesis And
    Lathyrus Lathyrism Newsletter 2 (2001) Similarities between Tropical Neurolathyrism Neurolathyrism is a neurologic disorder caused by Spastic Paraparesis (TSP) and excessive ingestion of Lathyrus species. Lathyrism has neurolathyrism been known since ancient times; epidemics have occurred in some regions, including Russia, southern Europe, the Middle East and India, particularly during times of famine. At these times increased consumption of Lathyrus sativus, L. cicera and Vicia sativa has been implicated. Horses, cattle, swine and birds have been Vladimir Zaninovic’ affected. Emeritus Professor of Neurology, Universidad del Clinically, lathyrism often presents relatively rapidly Valle, Cali, Colombia after a prolonged period (months) of ingesting large amounts of the grain, often in the context of general malnutrition. Disease often commences with Email: [email protected] OR complaints of pain or cramps in the legs or in the [email protected] region of the lumbar spine. Lower extremity weakness and sphincter disfunction then develop, soon evolving into permanent spastic paraparesis. The cramping pains and the sphincter dysfunction usually subside when the intoxication ceases and spasticity develops7. There are a few pathologic studies of lathyrism, but a report by Hirano et al.8 confirms earlier descriptions of bilateral atrophy in the distal pyramidal tract in the lumbar cord. Additionally, there have been Tropical Spastic Paraparesis morphologic descriptions of degenerative changes in Tropical Spastic Paraparesis (TSP) is a slowly the spinocerebellar tracts and dorsal columns. In progressive spastic paraparesis with an insidious onset concert, these data suggest a central nervous system in adulthood. It has been found all around the world (CNS) disease expressed most pronouncedly in the (except in the poles), mainly in tropical and subtropical distribution of the longest CNS fibres.
    [Show full text]
  • Awareness and Knowledge of Konzo and Tropical Ataxic Neuropathy (TAN) Among Women in Andom Village - East Region, Cameroon
    International Journal of Research and Review www.ijrrjournal.com E-ISSN: 2349-9788; P-ISSN: 2454-2237 Original Research Article Awareness and Knowledge of Konzo and Tropical Ataxic Neuropathy (TAN) Among Women in Andom Village - East Region, Cameroon Esther Etengeneng Agbor1, J Howard Bradbury2, Jean Pierre Banea3, Mbu Daniel Tambi4,A Desire Mintop5, Koulbout David6, R Mendounento7 1Senior Lecturer/researcher, Department of Biochemistry, University of Dschang – Cameroon 2Evolution, Ecology and Genetics Research School of Biology, Australian National University, Canberra, ACT 0200 Australia 3Programme National de Nutrition (PRONANUT), Kinshasa, Democratic Republic of Congo (DRC) 4Lecturer, Department of Agricultural Economics, University of Dschang, Cameroon 5Medical Doctor, Regional delegation of Ministry of Public health – Bertoua, East region - Cameroon 6Administrator/researcher, Regional delegation of Ministry of Scientific Research and Innovation - Cameroon 7Medical personnel, Government health Centre – Andom, East Region – Cameroon. Corresponding author: Esther Etengeneng Agbor Received: 29/10/2014 Revised: 25/11/2014 Accepted: 25/11/2014 ABSTRACT Background: Konzo and Tropical Ataxic Neuropathy (TAN) are toxico – nutritional neurological diseases associated with sub-lethal and moderate dietary cyanide exposure respectively, resulting from the consumption of insufficiently processed cassava products. In Cameroon, the cassava growing and consuming rural communities appear to have little awareness and knowledge of these nutritional diseases. Objective: To provide a preliminary insight into the awareness and knowledge of Konzo and TAN among rural women specifically in Andom village located in the East Region of Cameroon. Methodology: A convenient sample of 57 women between the ages of 20 - 70 years from a cassava growing/consuming local community was surveyed about Konzo and TAN.
    [Show full text]
  • Neuro-Ophthalmologic Findings in Konzo, an Upper Motor Neuron Disorder in Africa
    European Journal of Ophthalmology / Vol. 13 no. 4, 2003 / pp. 383-389 Neuro-ophthalmologic findings in konzo, an upper motor neuron disorder in Africa J.-C.K. MWANZA 1,5, D. TSHALA-KATUMBAY 2,3, D.L. KAYEMBE 1, K.E. EEG-OLOFSSON 4, T. TYLLESKÄR 5 1 Department of Ophthalmology, Kinshasa University Hospital, Kinshasa 2 Department of Neurology, Kinshasa University Hospital, Kinshasa - Democratic Republic of Congo 3 Center for Research on Occupational and Environmental Toxicology, Oregon Health Sciences University, Portland, Oregon - USA 4 Department of Neurosciences, Section for Clinical Neurophysiology, Uppsala University Hospital, Uppsala - Sweden 5 Center for International Health, University of Bergen, Bergen - Norway PURPOSE. To investigate the neuro-ophthalmological manifestations in konzo, a non-pro- gressive symmetric spastic para/tetraparesis of acute onset associated with consumption of insufficiently processed bitter cassava roots combined with a low protein intake. METHODS. Twenty-one Congolese konzo patients underwent neuro-ophthalmological inves- tigations including visual acuity testing, assessment of light pupillary reflexes, evaluation of ocular motility and deviation, direct ophthalmoscopy, and visual field perimetry. Objec- tive refraction including retinoscopy and keratometry, and slit-lamp biomicroscopy were al- so done. RESULTS. Five patients had visual impairment, and 14 had temporal pallor of the optic disc. Fourteen presented visual field defects, the most frequent being concentric constriction and peripheral defects. Overall, 11 subjects had symptoms qualifying for the diagnosis of optic neuropathy. Two had spontaneous pendular nystagmus in primary position of gaze. Visual field defects and pallor of the optic discs were found in mild, moderate and severe forms of konzo. No correlation was found between the severity of the motor disability of konzo and the extent of visual field loss.
    [Show full text]
  • Reviewing the Effect of Bitter Cassava Neurotoxicity on the Motor Neurons of Cassava-Induced Konzo Disease on Wistar Rats Stella Enefa, Chikwuogwo W
    Saudi Journal of Medicine Abbreviated Key Title: Saudi J Med ISSN 2518-3389 (Print) |ISSN 2518-3397 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: https://saudijournals.com Original Research Article Model of Konzo Disease: Reviewing the Effect of Bitter Cassava Neurotoxicity on the Motor Neurons of Cassava-Induced Konzo Disease on Wistar Rats Stella Enefa, Chikwuogwo W. Paul, Lekpa K. David* Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria DOI: 10.36348/sjm.2020.v05i11.005 | Received: 05.10.2020 | Accepted: 21.10.2020 | Published: 28.11.2020 *Corresponding Author: Lekpa K. David Abstract Introduction: Cassava (Manihot Esculenta) is a staple food in tropical and subtropical regions in Africa, and is the main source of carbohydrate in these regions. Nevertheless, it contains cyanogenic glycosides metabolised to hydrogen cyanide, which has been shown by studies to affect the motor neurons of the central nervous system and causes neurodegenerative disease as konzo. However, the cassava-induced konzo disease and its neurotoxicity in rat model is yet to be explored. Method: 30 Adult female Wistar rats were assigned to 4 experimental groups (i) negative control n=5 (ii) positive control n=5, (iii) konzo-induced group n=15, (iv) protein-treated group n=5. The bitter cassava foods were taken by oral ingestion for a period of 5 weeks. Motor activity was evaluated using forelimb grip strength testing done weekly. RESULTS: There was significant difference in weight and forelimb grip strength between the negative control group and the konzo-induced group p˂0.05.
    [Show full text]
  • Epidemic Spastic Paraparesis in Bandundu (Zaire)
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.49.6.620 on 1 June 1986. Downloaded from Journal'of Neurology, Neurosurgery, and Psychiatry 1986;49:620-627 Epidemic spastic paraparesis in Bandundu (Zaire) H CARTON,* KAZADI KAYEMBE,t KABEYA,t ODIO, A BILLIAU§ K MAERTENSII From the Department ofNeurology, Catholic University ofLeuven, Belgium,* Centre Neuropsychopathologique University ofKinshasa, Zaire,t Hopital de Panzi, Bandundu, Zaire, Rega Institute, Catholic University of Leuven, Belgium,§ Department ofOphthalmology, University ofKinshasa, Zaire 11 SUMMARY Epidemiological findings of twenty sporadic cases of epidemic spastic paraparesis (buka-buka) in three areas of Bandundu (Zaire) are reported. These findings suggest the in- volvement of an infectious agent and do not support the hypothesis of a dietary cyanide intoxi- cation, which has been advanced to explain the outbreak of a very similar disease (Mantakassa) in Mozambique. Acute as well as chronic spastic paraparesis of un- covered essentially by a savanna highland of 900 m altitude, known origin is much more common in tropical coun- cut by forest galleries along the multiple rivers running in a tries than in temperate climates. Deficiencies or south-north direction. toxicities due to primitive diets as well as infectious Twenty patients residing in three localities more than agents have been implicated.' Sometimes these dis- 200 km apart, and belonging to three different tribes in eases occur in epidemics. The earliest documented Southern Bandundu were examined by two neurologists and one ophthalmologist. The histories were taken either in oneProtected by copyright. cases of epidemic spastic paraparesis in the Bandundu of the major languages of Zaire (Lingala) or in the local region of Zaire occurred in 1928 and were reported by languages: Kiyaka with the aid of a Muyaka physician, Trolli.2 Ever since there have been new outbreaks Tshitshokwe with the aid of the local schoolhead and Ki- affecting hundreds of cases in several areas of Band- suku with the aid of a local health worker.
    [Show full text]
  • Toxic Disorders of the Upper Motor Neuron System
    4738-Eisen-18 6/16/06 5:58 PM Page 361 Handbook of Clinical Neurology, Vol. 82 (3rd series) Motor Neuron Disorders and Related Diseases A.A. Eisen, P.J. Shaw, Editors © 2007 Elsevier B.V. All rights reserved Chapter 18 Toxic disorders of the upper motor neuron system D. DESIRE TSHALA-KATUMBAY* AND PETER S. SPENCER Center for Research on Occupational and Environmental Toxicology and Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA 18.1. Introduction 18.2. Epidemiology Dysfunction of the motor system has been associated 18.2.1. Historical background with dietary dependence on food plants with neurotoxic potential, notably the grass pea (chickling pea) and cas- Lathyrism has affected humans and animal populations sava (manioc), in various and geographically distinct since antiquity. The disease was known to ancient regions of the world. Reliance on grass pea (Lathyrus Hindus, to Hippocrates (460–377 BC), Pliny the Elder sativus or related neurotoxic species) or on insufficiently (23–79 AD), Pedanius Dioskurides (50 AD) and Galen processed bitter cassava (Manihot esculenta Crantz) as (130–210 AD) (Desparanches, 1829; Hippocrates, staples, the latter in association with malnutrition, has 1846; Proust, 1883; Hubert, 1886; Schuchardt, 1887; resulted in epidemics of (neuro)lathyrism and konzo Spirtoff, 1903). Lathyrism affects populations reliant (neurocassavism), respectively; these are clinically on food products derived from neurotoxic species of the similar self-limiting neurodegenerative disorders con- Lathyrus genus, member of the Fabacae family, most fined to the upper motor neuron system. Studies of out- commonly Lathyrus sativus (grass pea) (Stockman, breaks of lathyrism and konzo have suggested 1917; Selye, 1957; Dwivedi and Prasad, 1964; Rao et al., individual susceptibility to the toxic effects of these 1969; Kislev, 1985).
    [Show full text]
  • Geospatial Association of Endemicity of Ataxic Polyneuropathy and Highly Cyanogenic Cassava Cultivars Olusegun Steven Ayodele Oluwole1* and Adeyinka Oludiran2
    Oluwole and Oludiran International Journal of Health Geographics 2013, 12:41 INTERNATIONAL JOURNAL http://www.ij-healthgeographics.com/content/12/1/41 OF HEALTH GEOGRAPHICS RESEARCH Open Access Geospatial association of endemicity of ataxic polyneuropathy and highly cyanogenic cassava cultivars Olusegun Steven Ayodele Oluwole1* and Adeyinka Oludiran2 Abstract Background: Exposure to cyanide from cassava foods is present in communities where ataxic polyneuropathy is endemic. Ataxic polyneuropathy is endemic in coastal parts of southwest and southeast Nigeria, and coastal Newala, south India, but it has been reported in epidemic or endemic forms from Africa, Asia, or Caribbean. This study was done to determine if cyanogenicity of cassava cultivars is higher in lowland than highland areas, and if areas of endemicity of ataxic polyneuropathy colocalize with areas of highest cyanogenicity of cassava. Methods: Roots of cassava cultivars were collected from 150 farmers in 32 of 37 administrative areas in Nigeria. Global positioning system was used to determine the location of the roots. Roots were assayed for concentrations of cyanogens. Thin Plate Spline regression was used to produce the contour map of cyanogenicity of the study area. Contour maps of altitude of the endemic areas were produced. Relationship of cyanogenicity of cassava cultivars and altitude, and of locations of areas of high cyanogenicity and areas of endemicity were determined. Results: Geometrical mean (95% CI) cyanogen concentration was 182 (142–233) mg HCN eq/kg dry wt for cassava cultivars in areas ≤ 25 m above sea level, but 54 (43–66) mg HCN eq/kg dry wt for areas > 375 m. Non-spatial linear regression of altitude on logarithm transformed concentrations of cyanogens showed highly significant association, (p < 0.0001).
    [Show full text]
  • Konzo and Cassava Toxicity
    KONZO AND CASSAVA TOXICITY A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO Delphin DIASOLUA NGUDI Academic Year 2004-2005 KONZO AND CASSAVA TOXICITY: A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO KONZO-ZIEKTE EN DE TOXICITEIT VAN MANIOK: EEN STUDIE VAN DE VOEDINGSFACTOREN IN POPOKABAKA DISTRICT, DEMOCRATISCHE REPUBLIEK KONGO Door Delphin DIASOLUA NGUDI, M.Sc. Thesis submitted in fulfilment of the requirements for the degree of Doctor (Ph.D.) in Applied Biological Sciences Proefschrift voorgedragen tot het bekomen van de graad van Doctor in the Toegepaste Biologische Wetenschappen Op gezag van: Rector: Prof. Dr. Apr. A. DE LEENHEER Decaan: Promotoren: Prof. Dr. Ir. Herman VAN LANGENHOVE Prof. Dr. Patrick KOLSTEREN Prof. Dr. Ir. Fernand LAMBEIN CITATION “A person who has food has many problems. A person who has no food has only one problem” Chinese saying DEDICATION To Thérèse Luntala and our sons Berdit, Gaël and Beni In memory of my Grand Oncle André Banketa and my father Bernard Ngudi-a-nkama Promotoren: Prof. Dr. Patrick KOLSTEREN Vakgroep Voedselveiligheid en Voedselkwaliteit, Universiteit Gent Voedings unit, Prins Leopold Instituut voor Tropische Geneeskunde, Antwerpen Prof. Dr. Ir. Fernand LAMBEIN Instituut Planten Biotechnologie voor Ontwikkelingenlanden, Universiteit Gent Decaan: Prof. Dr. Ir. Herman VAN LANGENHOVE Academiejaar 2004 - 2005 Delphin DIASOLUA NGUDI KONZO AND CASSAVA TOXICITY A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO Proefschrift voorgedragen tot het bekomen van de graad van Doctor in de Toegepaste Biologische Wetenschappen Op gezag van de rector, Prof. Dr. Apr.
    [Show full text]
  • Contents 2,5 Differential Diagnosis of in the Same Population
    Working together to eliminate cyanide poisoning, konzo and tropical ataxic neuropathy (TAN). Cassava Cyanide Diseases Network Issue Number 12, December 2008 and konzo if both disorders occurred Contents 2,5 Differential diagnosis of in the same population. konzo from other tropical Konzo and TAN have been Differential diagnosis of diseases: a review attributed to dietary cyanide konzo from other tropical exposure from consumption of diseases: a review .............. 1 Konzo with its upper motor neurone insufficiently processed cassava manifestations can be confused with roots, but rates of exposure differ in 7 other diseases and differential both diseases. In contrast to konzo, Comparison of cassava flour diagnosis is important. Using the TAN is a progressive disorder with and gari .................................... 2 WHO criteria, konzo by its spastic slow onset that mainly affects older paraparesis can easily be adults. Furthermore, konzo involves distinguished from causes of flaccid damage to upper motor neurones Outbreak of konzo disease in paraplegia such as poliomyelitis, without sensory involvement, health region No. 2 of the leprosy or trauma.1 The commonest whereas TAN is mainly caused by damage of sensory neurons in the Central African Republic ....... 3 neurological diseases to be considered in its differential spinal cord resulting in ataxia. TAN diagnoses include neurolathyrism, rarely progresses to inability to walk, Endomyocardial fibrosis: Tropical Ataxic Neuropathy (TAN) whereas walking difficulties are the primary symptom of konzo and a cause still unknown ................ 4 and Tropical Spastic Paraparesis/ HTL V-I Associated Myelopathy high proportion of the konzo- (TSP/HAM) (see Table 1). affected subjects are unable to walk. About half of the TAN cases have Konzo is clinically very similar to optic atrophy which is rare among konzo cases.
    [Show full text]
  • Increased Sensitization of Health Workers Leading to Detection of Unintended Cases of Acute Flaccid Paralysis: a Case of a “Konzo” Outbreak in Western Zambia
    Medical Journal of Zambia, Vol. 43 (2): pp 57 - 60 (2016) ORIGINAL ARTICLE Increased Sensitization of Health Workers Leading to Detection of Unintended Cases of Acute Flaccid Paralysis: A Case of a “Konzo” Outbreak in Western Zambia A Mtonga1, P Mwaba2, MLM Mazaba1,3, E Chizema2, M Kapina2, S Mwangala4, A Silumesi4, F Masaninga5, T Masuka4, L Hachambwa5, O Siddiqi5, I Mweene-Ndumba1, JS Kachimba5, B Vwalika5, S Kagulura5, P Songolo1, J Mufunda1 1World Health Organization, Lusaka, Zambia, 2Ministry of Health, Lusaka, Zambia 3Copperbelt University School of Medicine, Ndola, Zambia 4Ministry of Health, Mongu, Zambia, 5University of Zambia, School of Medicine, Lusaka, Zambia ABSTRACT comprehensively investigated the cases. To improve the diagnosis a detailed case investigation form and checklist Background: The threat of high profile diseases causing were used to capture clinical data and socio demographic outbreaks has drawn attention to public health information. surveillance systems, much needed for the timely detection of outbreaks. A disease characterized by Laboratory investigations included routine urine weakness of the lower limbs in Luatembo rural health microscopy and full blood count. Further analysis facility was reported to the province in 2013. Through the included viral analysis for enteroviruses, Acute Flaccid Paralysis surveillance (AFP) program the cytomegalovirus among others, copper levels and Western Province in Zambia recorded an increase in the thiocyanate levels. numbers of people affected with spastic paraparesis. The disease affected clusters of families, especially women Results: Preliminary laboratory results indicated no viral and children. The disease was found to be in specific infections. Thiocyanate and copper levels are yet to be geographic areas, with the initial cases being identified in analysed.
    [Show full text]