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Microbes Infect. 2015 Oct;17(10):671-5. doi: 10.1016/j.micinf.2015.08.005. Epub 2015 Aug 28.

Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology?

Author information

1
Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA. Electronic address: kmurray@bcm.edu.
2
Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
3
Ingenio San Antonio, Chichigalpa, Nicaragua.
4
Universidad Nacional Autonoma de Nicaragua, León, (UNAN León), College of Veterinary Medicine, León, Nicaragua.
5
Boston University, School of Public Health, Boston, MA, USA.
6
Baylor College of Medicine, Department of Medicine, Houston, TX, USA.
7
Universidad Nacional Autonoma de Nicaragua León (UNAN León), College of Veterinary Medicine, León, Nicaragua.

Abstract

An outbreak of unexplained and severe kidney disease, "Mesoamerican Nephropathy," in mostly young, male sugar cane workers emerged in Central America in the late 1990's. As a result, an estimated 20,000 individuals have died, to date. Unfortunately, and with great consequence to human life, the etiology of the outbreak has yet to be identified. The sugarcane fields in Chichigalpa, Chinandega, Nicaragua, have been involved in the outbreak, and during our initial investigation, we interviewed case patients who experienced fever, nausea and vomiting, arthralgia, myalgia, headache, neck and back pain, weakness, and paresthesia at the onset of acute kidney disease. We also observed a heavy infestation of rodents, particularly of Sigmodon species, in the sugarcane fields. We hypothesize that infectious pathogens are being shed through the urine and feces of these rodents, and workers are exposed to these pathogens during the process of cultivating and harvesting sugarcane. In this paper, we will discuss the epidemic in the Chichigalpa area, potential pathogens responsible for Mesoamerican Nephropathy, and steps needed in order to diagnose, treat, and prevent future cases from occurring.

KEYWORDS:

Acute interstitial nephritis; Acute kidney injury; Chronic kidney disease of unknown etiology, CKDu; Hantavirus; Leptospirosis; Mesoamerican nephropathy; Nicaragua; Sugarcane

PMID:
26320026
DOI:
10.1016/j.micinf.2015.08.005
[Indexed for MEDLINE]

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