Epidemic Optic Neuropathy in Cuba — Clinical Characterization and Risk Factors

Team, Cuba Neuropathy Field Investigation

doi:10.1056/nejm199511023331803

Cited by 150 publications

(15 citation statements)

References 21 publications

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“…Large-scale outbreaks of peripheral neuropathy have been associated with food shortages and low intakes of animal fat and protein [23]. Similar to previously investigated outbreaks [4], [5], overt malnutrition was not present in this population, but multiple micronutrient deficiencies were identified. Of the malnutrition-related neurological disorders, peripheral neuropathy has been associated with several micronutrient deficiencies, including copper [24], chromium, pyridoxine (B6) [25] and cobalamin (B12) and thiamine (B1), which are most frequently reported among confined populations [26].…”

Section: Discussionsupporting

confidence: 82%

“…Outbreaks of optic and peripheral neuropathy, for which the identification of a definitive cause is challenging, have been reported in association with dietary inadequacies [4], [5]. Despite numerous reports of both cholera [6] and peripheral neuropathy [3] among internally displaced persons (IDPs), the epidemiological features of their concurrent outbreaks and their impact on mortality have not been previously described.…”

Section: Introductionmentioning

confidence: 99%

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Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Rosewell

Clark²,

Mabong³

et al. 2013

PLoS ONE

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BackgroundIn October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population.Materials and MethodsA retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).ResultsThere were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy.ConclusionsCholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Rosewell

Clark²,

Mabong³

et al. 2013

PLoS ONE

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“…The Cuban optic neuropathy epidemic associated the use of tobacco, especially cigars, and malnutrition, to vision loss from an optic neuropathy. [48] Susceptible individuals who harbor the mitochondrial DNA mutations associated with LHON should be counseled to avoid smoking. Kirkman et al found that smoking significantly increased the risk of vision loss in patients harboring mutations for LHON.…”

Section: Optic Nervementioning

confidence: 99%

Ocular manifestations of drug and alcohol abuse

Peragallo¹,

Biousse²,

Newman

2013

Current Opinion in Ophthalmology

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Purpose of review To review commonly encountered adverse ocular effects of illicit drug use. Recent findings Drug and alcohol abuse can produce a variety of ocular and neuro-ophthalmic side effects. Novel, so-called “designer,” drugs of abuse can lead to unusual ocular disorders. Legal substances, when used in manners for which they have not been prescribed, can also have devastating ophthalmic consequences. Summary In this review we will systematically evaluate each part of the visual pathways and discuss how individual drugs may affect them.

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“…In another Latin American example, in 1994, the Cuban government issued a policy of supplementation of multivitamin pills containing 400 µg of folic acid to all the adult population, after an epidemic of optic neuropathy attributed to an ill-defined vitamin deficiency and possible food toxics [55]. In addition, as described below, since the mid-1980s Cuba has implemented a very successful program of prenatal detection of neural tube defects based on prenatal α-fetoprotein and ultrasound screening, followed by the option of terminating affected pregnancies.…”

Section: Prevention Of Congenital Anomaliesmentioning

confidence: 99%

Preventing Congenital Anomalies in Developing Countries

Penchaszadeh¹

2002

Public Health Genomics

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The birth prevalence of congenital anomalies in developing countries is similar to that observed in developed countries. However, the health impact of birth defects is higher because of a lack of adequate services for the care of affected infants and a higher rate of exposures to infections and malnutrition. A number of successful measures for the prevention of congenital anomalies are being taken in a number of developing nations. Primary prevention programs are based on public education about preconceptional and prenatal risks. Prevention based on reproduction options includes teratogen information services and prenatal screening for fetal anomalies. In addition, programs for the detection of congenital malformations at birth, followed by early treatment, are contributing to secondary prevention. Prevention of congenital anomalies in the developing world requires: (a) good epidemiological data on the prevalence and types of birth defects and genetic disorders; (b) educating health professionals in the goals and methods of preventing birth defects at low cost but with high impact, and (c) expansion of family planning and improvement of antenatal care combined with educational campaigns to avoid the risks for birth defects. The basis for public health preventive measures should be the primary health care level. In a sizable proportion of developing countries, the stage is already set for these measures to be implemented. Required are education, political will, and proper organization and allocation of resources.

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Epidemic Optic Neuropathy in Cuba — Clinical Characterization and Risk Factors

Abstract: The epidemic of optic and peripheral neuropathy in Cuba between 1991 and 1993 appears to be linked to reduced nutrient intake caused by the country's deteriorating economic situation and the high prevalence of tobacco use.

Cited by 150 publications

References 21 publications

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Ocular manifestations of drug and alcohol abuse

Preventing Congenital Anomalies in Developing Countries

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