title: Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology?
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.
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA. Electronic address: kmurray@bcm.edu.
authors: Kristy O
authors: KO
authors: Murray
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
authors: Rebecca S B
authors: RS
authors: Fischer
authors: Ingenio San Antonio, Chichigalpa, Nicaragua.
authors: Denis
authors: D
authors: Chavarria
authors: Universidad Nacional Autonoma de Nicaragua, León, (UNAN León), College of Veterinary Medicine, León, Nicaragua.
authors: Christiane
authors: C
authors: Duttmann
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
authors: Melissa N
authors: MN
authors: Garcia
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
authors: Rodion
authors: R
authors: Gorchakov
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
authors: Peter J
authors: PJ
authors: Hotez
authors: Universidad Nacional Autonoma de Nicaragua, León, (UNAN León), College of Veterinary Medicine, León, Nicaragua.
authors: William
authors: W
authors: Jiron
authors: Boston University, School of Public Health, Boston, MA, USA.
authors: Jessica H
authors: JH
authors: Leibler
authors: Baylor College of Medicine and Texas Children's Hospital, Section of Pediatric Tropical Medicine, Houston, TX, USA.
authors: Job E
authors: JE
authors: Lopez
authors: Baylor College of Medicine, Department of Medicine, Houston, TX, USA.
authors: Sreedhar
authors: S
authors: Mandayam
authors: Ingenio San Antonio, Chichigalpa, Nicaragua.
authors: Alejandro
authors: A
authors: Marin
authors: Universidad Nacional Autonoma de Nicaragua León (UNAN León), College of Veterinary Medicine, León, Nicaragua.
authors: Jessica
authors: J
authors: Sheleby
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000473:pathology; D000818:Animals; D003141:Communicable Diseases / Q000453:epidemiology / Q000473:pathology; D004196:Disease Outbreaks; D006801:Humans; D008297:Male; D009395:Nephritis, Interstitial / Q000150:complications / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D009527:Nicaragua / Q000453:epidemiology; D031786:Saccharum / Q000254:growth & development; D016205:Sigmodontinae / Q000254:growth & development; D014329:Tropical Climate; D015047:Zoonoses / Q000453:epidemiology / Q000473:pathology
keywords: Acute interstitial nephritis; Acute kidney injury; Chronic kidney disease of unknown etiology, CKDu; Hantavirus; Leptospirosis; Mesoamerican nephropathy; Nicaragua; Sugarcane