Omar K Siddiqi1, Muzala Kapina2, Ramya Kumar2, Albertina Ngomah Moraes2, Patrick Kabwe2, Mazyanga L Mazaba2, Lottie Hachaambwa2, Namalambo Mwenda Ng'uni2, Patrick C Chikoti2, Maria Morel-Espinosa2, Jeffery M Jarrett2, Henry C Baggett2, Elizabeth Chizema-Kawesha2. 1. From the Department of Internal Medicine (O.K.S., L.H.), University of Zambia School of Medicine, Lusaka; Global Neurology Program (O.K.S.), Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Ministry of Health (M.K., E.C.-K.); ASPPH/CDC Allan Rosenfield Global Health Fellowship Program (R.K.), Lusaka; Department of Public Health and Research (A.N.M.) and Zambia Field Epidemiology Training Program (P.K.), Ministry of Health; World Health Organization (M.L.M.); Virology Laboratory (M.L.M.) and Department of Physiotherapy (M.N.M.), Children's Hospital, University Teaching Hospital, Lusaka, Zambia; Institute of Human Virology (L.H.), Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore; Zambia Agriculture Research Institute (P.C.C.), Plant Protection and Quarantine Division, Lusaka; and Centers for Disease Control and Prevention (M.M.-E., J.M.J., H.C.B.), Atlanta, GA. osiddiqi@bidmc.harvard.edu. 2. From the Department of Internal Medicine (O.K.S., L.H.), University of Zambia School of Medicine, Lusaka; Global Neurology Program (O.K.S.), Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Ministry of Health (M.K., E.C.-K.); ASPPH/CDC Allan Rosenfield Global Health Fellowship Program (R.K.), Lusaka; Department of Public Health and Research (A.N.M.) and Zambia Field Epidemiology Training Program (P.K.), Ministry of Health; World Health Organization (M.L.M.); Virology Laboratory (M.L.M.) and Department of Physiotherapy (M.N.M.), Children's Hospital, University Teaching Hospital, Lusaka, Zambia; Institute of Human Virology (L.H.), Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore; Zambia Agriculture Research Institute (P.C.C.), Plant Protection and Quarantine Division, Lusaka; and Centers for Disease Control and Prevention (M.M.-E., J.M.J., H.C.B.), Atlanta, GA.
Abstract
OBJECTIVE: To identify the etiology of an outbreak of spastic paraparesis among women and children in the Western Province of Zambia suspected to be konzo. METHODS: We conducted an outbreak investigation of individuals from Mongu District, Western Province, Zambia, who previously developed lower extremity weakness. Cases were classified with the World Health Organization definition of konzo. Active case finding was conducted through door-to-door evaluation in affected villages and sensitization at local health clinics. Demographic, medical, and dietary history was used to identify common exposures in all cases. Urine and blood specimens were taken to evaluate for konzo and alternative etiologies. RESULTS: We identified 32 cases of konzo exclusively affecting children 6 to 14 years of age and predominantly females >14 years of age. Fourteen of 15 (93%) cases ≥15 years of age were female, 11 (73%) of whom were breastfeeding at the time of symptom onset. Cassava was the most commonly consumed food (median [range] 14 [4-21] times per week), while protein-rich foods were consumed <1 time per week for all cases. Of the 30 patients providing urine specimens, median thiocyanate level was 281 (interquartile range 149-522) μmol/L, and 73% of urine samples had thiocyanate levels >136 μmol/L, the 95th percentile of the US population in 2013 to 2014. CONCLUSION: This investigation revealed the first documented cases of konzo in Zambia, occurring in poor communities with diets high in cassava and low in protein, consistent with previous descriptions from neighboring countries.
OBJECTIVE: To identify the etiology of an outbreak of spastic paraparesis among women and children in the Western Province of Zambia suspected to be konzo. METHODS: We conducted an outbreak investigation of individuals from Mongu District, Western Province, Zambia, who previously developed lower extremity weakness. Cases were classified with the World Health Organization definition of konzo. Active case finding was conducted through door-to-door evaluation in affected villages and sensitization at local health clinics. Demographic, medical, and dietary history was used to identify common exposures in all cases. Urine and blood specimens were taken to evaluate for konzo and alternative etiologies. RESULTS: We identified 32 cases of konzo exclusively affecting children 6 to 14 years of age and predominantly females >14 years of age. Fourteen of 15 (93%) cases ≥15 years of age were female, 11 (73%) of whom were breastfeeding at the time of symptom onset. Cassava was the most commonly consumed food (median [range] 14 [4-21] times per week), while protein-rich foods were consumed <1 time per week for all cases. Of the 30 patients providing urine specimens, median thiocyanate level was 281 (interquartile range 149-522) μmol/L, and 73% of urine samples had thiocyanate levels >136 μmol/L, the 95th percentile of the US population in 2013 to 2014. CONCLUSION: This investigation revealed the first documented cases of konzo in Zambia, occurring in poor communities with diets high in cassava and low in protein, consistent with previous descriptions from neighboring countries.
Authors: J N Chabwine; C Masheka; Z Balol'ebwami; B Maheshe; S Balegamire; B Rutega; M Wa Lola; K Mutendela; M-J Bonnet; O Shangalume; J M Balegamire; B Nemery Journal: Food Chem Toxicol Date: 2010-08-04 Impact factor: 6.023
Authors: Mark W Lehman; Allen S Craig; Constantine Malama; Muzala Kapina-Kany'anga; Philip Malenga; Fanny Munsaka; Sergio Muwowo; Sean Shadomy; Melissa A Marx Journal: Emerg Infect Dis Date: 2017-09 Impact factor: 6.883