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Impact of Seasonal Variation and Processing Methods on the Cassava-Derived Dietary Cyanide Poisoning, Nutritional Status, and Konzo Appearance in South-Kivu, Eastern D.R. Congo. Processes (Basel) 2022. [DOI: 10.3390/pr10020337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed at evaluating the impact of seasons on the nutritional status and on dietary cassava-related cyanide exposure in Burhinyi and Idjwi, two areas in the eastern Democratic Republic of the Congo, witnessing similarly high cassava-derived cyanide poisoning but differently affected by konzo and malnutrition. Cyanide content in cassava roots and flour, and urinary thiocyanate levels (uSCN) of 54 subjects (40 from Burhinyi and 14 from Idjwi, aged 28.7 (12.1) years, 63% women) were measured during the rainy season (RS) and dry season (DS), using picrate paper kits A and D1. Local processing methods proved to be efficient in removing cyanogenic compounds in fresh cassava roots during the RS. However, the cyanide content in flour samples significantly increased during DS, with ~50% of samples containing unsafe levels (>10 ppm) of cyanide content. Strikingly, the uSCN (µmol/L), from being comparably high in RS (~172.0), slightly decreased during DS in Burhinyi (~103.2; p = 0,3547), but not in Idjwi (~172; p = 0,1113). Furthermore, serum proteins and albumin levels significantly decreased during the DS, witnessing a worsening of nutritional status, in Burhinyi but not in Idjwi. The consumption of bitter cassava roots (OR = 5.43, p = 0.0144) and skipping heap fermentation (OR = 16.67, p = 0.0021) were independently associated with very high uSCN levels during the DS. Thus, restoring the traditional processing methods, and complying with them in either season should ensure the safe consumption of cassava.
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Acceptability of Vegetable Fortified Ugali in Sub-Saharan Africa. Nutrients 2021; 13:nu13103405. [PMID: 34684406 PMCID: PMC8537100 DOI: 10.3390/nu13103405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Corn flour-based porridge like dough, ugali, is the staple food of low-income population in sub-Saharan Africa. Lack of vitamin A, carotenoids, and dietary fibers brings about serious health issues to this population. In this study, vegetables including bok choy, broccoli, cabbage, carrot, Chinese onion stalk (C_onion), mushroom, are added during the cooking of ugali, as nutritional supplements. The freeze-dried powder of each vegetable was used for its long storage, stable nutrients, and similar particle size. Sub-Saharan African assessors were trained and sensory evaluated the six different vegetable fortified ugali with the plain, unfortified as the control on five attributes. The plain ugali was indistinguishable with the C_onion stalk fortified in color, with the carrot and C_onion stalk fortified in odor, with all vegetables (except broccoli and mushroom) fortified ugali in taste, with carrot and C_onion stalk fortified in granularity, and with cabbage, carrot, C_onion stalk fortified in viscosity. Preference ranking analysis showed that the C_onion stalk fortified ugali is even more favorably preferred than the plain, unfortified ugali, probably due to the umami components in C_onion that serve as the taste enhancer. This study indicates that Chinese onion stalk is a potential vegetable supplement to population in the sub-Saharan Africa.
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Baguma M, Nzabara F, Maheshe Balemba G, Malembaka EB, Migabo C, Mudumbi G, Bito V, Cliff J, Rigo JM, Chabwine JN. Konzo risk factors, determinants and etiopathogenesis: What is new? A systematic review. Neurotoxicology 2021; 85:54-67. [PMID: 33964344 DOI: 10.1016/j.neuro.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
Konzo is a toxico-nutritional upper motor neuron disease causing a spastic paraparesis in schoolchildren and childbearing women in some African countries. Almost a century since the first description of konzo, its underlying etiopathogenic mechanisms and causative agent remain unknown. This paper aims at refreshing the current knowledge of konzo determinants and pathogenesis in order to enlighten potential new research and management perspectives. Literature research was performed in PubMed and Web of Science databases according to the PRISMA methodology. Available data show that cassava-derived cyanide poisoning and protein malnutrition constitute two well-documented risk factors of konzo. However, observational studies have failed to demonstrate the causal relationship between konzo and cyanide poisoning. Thiocyanate, the current marker of choice of cyanide exposure, may underestimate the actual level of cyanide poisoning in konzo patients as a larger amount of cyanide is detoxified via other unusual pathways in the context of protein malnutrition characterizing these patients. Furthermore, the appearance of konzo may be the consequence of the interplay of several factors including cyanide metabolites, nutritional deficiencies, psycho-emotional and geo-environmental factors, resulting in pathophysiologic phenomena such as excitotoxicity or oxidative stress, responsible for neuronal damage that takes place at sparse cellular and/or subcellular levels.
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Affiliation(s)
- Marius Baguma
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium.
| | - Fabrice Nzabara
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Ghislain Maheshe Balemba
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Christiane Migabo
- Faculty of Agronomy, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Department of Geography and Environmental Studies, College of Social Sciences and Humanities, Jimma University, Jimma, Ethiopia
| | - Germain Mudumbi
- Department of Pediatrics, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Virginie Bito
- Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
| | - Julie Cliff
- Faculty of Medicine, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Jean-Michel Rigo
- Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
| | - Joëlle Nsimire Chabwine
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Rosas-Jarquín CDJ, Rivadeneyra-Domínguez E, León-Chávez BA, Nadella R, Sánchez-García ADC, Rembao-Bojórquez D, Rodríguez-Landa JF, Hernandez-Baltazar D. Chronic consumption of cassava juice induces cellular stress in rat substantia nigra. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:93-101. [PMID: 32405352 PMCID: PMC7206837 DOI: 10.22038/ijbms.2019.38460.9131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Cassava (Manihot esculenta Crantz) contains cyanogenic glycosides (linamarin and lotaustralin) that have been associated with neurological disorders in humans and rats. In basal ganglia, the dopaminergic neurons of substantia nigra pars compacta (SNpc) show high cytotoxic susceptibility; therefore, the chronic consumption of cassava (CCC) could induce neurodegeneration in SNpc. In this study we examine the impact of CCC on the integrity of the nigrostriatal system, including apoptosis and microgliosis. MATERIALS AND METHODS Male Wistar rats were administered cassava juice daily (3.57 g/kg and 28.56 g/kg, per os) or linamarin (0.15 mg/ml, IP), and its effects were evaluated in rota-rod and swim tests at days 7, 14, 21, 28, and 35 of administration. In SNpc, oxidative/nitrosative stress was determined by malondialdehyde/4-hydroxyalkenals (MDA-4-HAD) and nitrite contents. Tyrosine hydroxylase immunoreactivity (TH-IR) was evaluated in SNpc, neostriatum (NE), and nucleus accumbens (NA). Apoptosis and microgliosis were determined by active-caspase-3 (C3) and CD11b/c (OX42) expression in the medial region of SNpc. RESULTS Chronic administration of cassava juice, or linamarin, increased motor impairment. The rats that received 28.56 g/kg cassava showed increased MDA-4-HAD content in SNpc and nitrite levels in NE with respect to controls. Significant loss of TH-IR in SNpc, NE, and NA was not found. The 28.56 g/kg cassava administration produced dopaminergic atrophy and microgliosis, whereas linamarin induced hypertrophy and C3-related apoptosis in SNpc. CONCLUSION CCC induces cellular stress on dopaminergic neurons, which could contribute to motor impairment in the rat.
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Affiliation(s)
| | | | | | - Rasajna Nadella
- IIIT Srikakulam, Rajiv Gandhi University of Knowledge Technologies (RGUKT); International collaboration ID: 1840; India
| | | | - Daniel Rembao-Bojórquez
- Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez”. Ciudad de México. Mexico
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Rivadeneyra-Domínguez E, Rodríguez-Landa JF. Preclinical and clinical research on the toxic and neurological effects of cassava (Manihot esculenta Crantz) consumption. Metab Brain Dis 2020; 35:65-74. [PMID: 31802307 DOI: 10.1007/s11011-019-00522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
Cassava (Manihot esculenta Crantz) is a tropical plant that is used as fresh food, processed food, or raw material for the preparation of flours with high nutritional value. However, cassava contains cyanogenic glycosides, such as linamarin and lotaustralin, that can trigger severe toxic effects and some neurological disorders, including motor impairment, cognitive deterioration, and symptoms that characterize tropical ataxic neuropathy and spastic epidemic paraparesis (Konzo). These alterations that are associated with the consumption of cassava or its derivatives have been reported in both humans and experimental animals. The present review discusses and integrates preclinical and clinical evidence that indicates the toxic and neurological effects of cassava and its derivatives by affecting metabolic processes and the central nervous system. An exhaustive review of the literature was performed using specialized databases that focused on the toxic and neurological effects of the consumption of cassava and its derivatives. We sought to provide structured information that will contribute to understanding the undesirable effects of some foods and preventing health problems in vulnerable populations who consume these vegetables. Cassava contains cyanogenic glycosides that contribute to the development of neurological disorders when they are ingested inappropriately or for prolonged periods of time. Such high consumption can affect neurochemical and neurophysiological processes in particular brain structures and affect peripheral metabolic processes that impact wellness. Although some vegetables have high nutritional value and ameliorate food deficits in vulnerable populations, they can also predispose individuals to the development of neurological diseases.
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Affiliation(s)
- E Rivadeneyra-Domínguez
- Facultad de Química Farmacéutica Biológica, Universidad Veracruzana, Xalapa, 91000, Veracruz, Mexico.
| | - J F Rodríguez-Landa
- Facultad de Química Farmacéutica Biológica, Universidad Veracruzana, Xalapa, 91000, Veracruz, Mexico
- Laboratorio de Neurofarmacología, Instituto de Neuroetología, Universidad Veracruzana, Xalapa, 91190, Veracruz, Mexico
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Plants with neurotoxic potential in undernourished subjects. Rev Neurol (Paris) 2019; 175:631-640. [DOI: 10.1016/j.neurol.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
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Boivin MJ, Okitundu D, Makila-Mabe B, Sombo MT, Mumba D, Sikorskii A, Mayambu B, Tshala-Katumbay D. Cognitive and motor performance in Congolese children with konzo during 4 years of follow-up: a longitudinal analysis. Lancet Glob Health 2017; 5:e936-e947. [PMID: 28807191 PMCID: PMC5594926 DOI: 10.1016/s2214-109x(17)30267-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Konzo is an irreversible upper-motor neuron disorder affecting children dependent on bitter cassava for food. The neurocognitive ability of children with konzo over time has yet to be fully documented. METHODS We did a longitudinal study in a konzo outbreak zone continuously affected by konzo since 1990, in the district of Kahemba, southern Bandundu Province, Congo. We enrolled children with a record of neurological diagnosis of konzo in Kahemba town. For all study children with konzo enrolled in the final sample for the baseline assessment, a neurological exam was done by neurologists to confirm konzo diagnosis using the 1996 WHO criteria at 2 years and 4 years. In the initial baseline sample for each child with konzo, we attempted to get consent from a comparison child without konzo (1996 WHO criteria) within 2 years of age, from a neighbouring household who met inclusion criteria. The neuropsychological assessments were the Kaufman Assessment Battery for Children, second edition (KABC-II), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). FINDINGS Data collection occurred between Oct 12, 2011, and Aug 14, 2015, in the town of Kahemba. 123 children from the Congo with konzo and 87 presumably healthy children without konzo from neighbouring households were enrolled. The planned assessments were completed by 76 children with konzo and 82 children without konzo at 2-year follow-up, and by 55 children with konzo and 33 children without konzo at 4-year follow-up. Boys with konzo did worse than those without konzo on the KABC-II Learning (p=0·0424) and on the Mental Processing Index (MPI; p=0·0111) assessments at 2-year follow-up, but girls did not. These differences observed in boys might have been caused by stunting. At 4-year follow-up, the difference in KABC-II MPI score between boys or girls with or without konzo was not significant. Both boys and girls with konzo had lower scores on BOT-2 than children without konzo at both follow-up times (p<0·0001). These differences were not attenuated when controlling for physical growth. Boys with and without konzo declined on BOT-2 fine motor proficiency at 2-year follow-up (boys with konzo p=0·0076; boys without konzo p=0·0224) and KABC-II MPI performance at 2-year follow-up and 4-year follow-up (2 years: boys with konzo p<0·0001, boys without konzo p=0·0213; 4 years: boys with konzo p=0·0256, boys without konzo p=0·10), but that was not the case for the girls with scores remaining stable regardless of konzo status. For boys, increases in urinary thiocyanate concentration was significantly associated with reductions in BOT-2 motor proficiency (p=0·0321), but was not significantly associated in girls and urinary thiocyanate concentration was not associated with KABC-II MPI score for either boys or girls. INTERPRETATION Motor and cognitive performance continues to be significantly impaired in boys with konzo at 2-year follow-up compared with boys without konzo. Because these impairments are associated in part with exposure to poorly processed cassava as measured by urinary thiocyanate, interventions are urgently needed to ensure improved processing of cassava to detoxify this food source. FUNDING US National Institutes of Health.
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Affiliation(s)
- Michael J Boivin
- Department of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - Daniel Okitundu
- Centre NeuroPsychopathologique (CNPP), University of Kinshasa, Kinshasa, Congo
| | - Bumoko Makila-Mabe
- Centre NeuroPsychopathologique (CNPP), University of Kinshasa, Kinshasa, Congo
| | - Marie-Therese Sombo
- Centre NeuroPsychopathologique (CNPP), University of Kinshasa, Kinshasa, Congo
| | - Dieudonne Mumba
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Congo; National Institute for Biomedical Research (INRB), Kinshasa, Congo
| | - Alla Sikorskii
- Department of Psychiatry and Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
| | - Banea Mayambu
- Ministry of Health National Program on Nutrition (PRONANUT), Kinshasa, Congo
| | - Desire Tshala-Katumbay
- Centre NeuroPsychopathologique (CNPP), University of Kinshasa, Kinshasa, Congo; National Institute for Biomedical Research (INRB), Kinshasa, Congo; Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Tshala-Katumbay DD, Ngombe NN, Okitundu D, David L, Westaway SK, Boivin MJ, Mumba ND, Banea JP. Cyanide and the human brain: perspectives from a model of food (cassava) poisoning. Ann N Y Acad Sci 2016; 1378:50-57. [PMID: 27450775 DOI: 10.1111/nyas.13159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/29/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
Threats by fundamentalist leaders to use chemical weapons have resulted in renewed interest in cyanide toxicity. Relevant insights may be gained from studies on cyanide mass intoxication in populations relying on cyanogenic cassava as the main source of food. In these populations, sublethal concentrations (up to 80 μmol/l) of cyanide in the blood are commonplace and lead to signs of acute toxicity. Long-term toxicity signs include a distinct and irreversible spastic paralysis, known as konzo, and cognition deficits, mainly in sequential processing (visual-spatial analysis) domains. Toxic culprits include cyanide (mitochondrial toxicant), thiocyanate (AMPA-receptor chaotropic cyanide metabolite), cyanate (protein-carbamoylating cyanide metabolite), and 2-iminothiazolidine-4-carboxylic acid (seizure inducer). Factors of susceptibility include younger age, female gender, protein-deficient diet, and, possibly, the gut functional metagenome. The existence of uniquely exposed and neurologically affected populations offers invaluable research opportunities to develop a comprehensive understanding of cyanide toxicity and test or validate point-of-care diagnostic tools and treatment options to be included in preparedness kits in response to cyanide-related threats.
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Affiliation(s)
- Desire D Tshala-Katumbay
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon. .,Department of Neurology, University of Kinshasa, Kinshasa, Congo. .,National Nutrition Program, Ministry of Health, and Kinshasa School of Public Health, Kinshasa, Congo.
| | | | - Daniel Okitundu
- Department of Neurology, University of Kinshasa, Kinshasa, Congo
| | - Larry David
- Department of Biochemistry and Proteomic Share Resource, Oregon Health & Science University, Portland, Oregon
| | - Shawn K Westaway
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Michael J Boivin
- Department of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan
| | - Ngoyi D Mumba
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Congo.,Institut National de Recherches Biomédicales (INRB), Kinshasa, Congo
| | - Jean-Pierre Banea
- National Nutrition Program, Ministry of Health, and Kinshasa School of Public Health, Kinshasa, Congo
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Kambale KJ, Ali ER, Sadiki NH, Kayembe KP, Mvumbi LG, Yandju DL, Boivin MJ, Boss GR, Stadler DD, Lambert WE, Lasarev MR, Okitundu LA, Mumba Ngoyi D, Banea JP, Tshala-Katumbay DD. Lower sulfurtransferase detoxification rates of cyanide in konzo-A tropical spastic paralysis linked to cassava cyanogenic poisoning. Neurotoxicology 2016; 59:256-262. [PMID: 27246648 DOI: 10.1016/j.neuro.2016.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/17/2022]
Abstract
Using a matched case-control design, we sought to determine whether the odds of konzo, a distinct spastic paraparesis associated with food (cassava) cyanogenic exposure in the tropics, were associated with lower cyanide detoxification rates (CDR) and malnutrition. Children with konzo (N=122, 5-17 years of age) were age- and sex-matched with presumably healthy controls (N=87) and assessed for motor and cognition performances, cyanogenic exposure, nutritional status, and cyanide detoxification rates (CDR). Cyanogenic exposure was ascertained by thiocyanate (SCN) concentrations in plasma (P-SCN) and urine (U-SCN). Children with a height-for-age z-score (HAZNCHS)<-2 were classified as nutritionally stunted. CDR was measured as time required to convert cyanide to SCN, and expressed as ms/μmol SCN/mg protein or as mmolSCN/ml plasma/min. Mean (SD) U-SCN in children with konzo was 521.9 (353.6) μmol/l and was, significantly higher than 384.6 (223.7) μmol/l in those without konzo. Conditional regression analysis of data for age- and sex- matched case-control pairs showed that konzo was associated with stunting (OR: 5.8; 95% CI: 2.7-12.8; p<0.01; N=83 paired groups) and higher U-SCN (OR: 1.1; 95% CI: 1.02-1.20 per 50-μmol increase in U-SCN; p=0.02; N=47 paired groups). After adjusting for stunting and U-SCN, the odds of developing konzo was reduced by 63% (95% CI: 11-85%, p=0.03; N=41 paired groups) for each 5mmol SCN/(ml plasma/min)-increase in CDR. Linear regression analysis indicated a significant association between BOT-2 or KABC-II scores and both the HAZNCHS z-score and the U-SCN concentration, but not the CDR. Our findings provide evidence in support of interventions to remove cyanogenic compounds from cassava prior to human consumption or, peharps, enhance the detoxification of cyanide in those relying on the cassava as the main source of food.
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Affiliation(s)
- K J Kambale
- Department of Biomedical Sciences, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - E R Ali
- Department of Biology, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo; Institut National de Recherches Biomédicales (INRB), Congo-Kinshasa, Democratic Republic of the Congo
| | - N H Sadiki
- School of Public Health, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - K P Kayembe
- School of Public Health, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - L G Mvumbi
- Department of Biomedical Sciences, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - D L Yandju
- Department of Biology, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - M J Boivin
- Department of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, MI, USA
| | - G R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - D D Stadler
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, USA
| | - W E Lambert
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - M R Lasarev
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - L A Okitundu
- Department of Neurology, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo
| | - D Mumba Ngoyi
- Department of Tropical Medicine, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo; Institut National de Recherches Biomédicales (INRB), Congo-Kinshasa, Democratic Republic of the Congo
| | - J P Banea
- School of Public Health, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo; National Nutrition Program, Ministry of Health, Congo-Kinshasa, Democratic Republic of the Congo
| | - D D Tshala-Katumbay
- Department of Neurology, University of Kinshasa, Congo-Kinshasa, Democratic Republic of the Congo; Institut National de Recherches Biomédicales (INRB), Congo-Kinshasa, Democratic Republic of the Congo; Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
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10
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Oluwole OSA. Cyclical konzo epidemics and climate variability. Ann Neurol 2015; 77:371-80. [PMID: 25523348 DOI: 10.1002/ana.24334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/30/2014] [Accepted: 12/07/2014] [Indexed: 11/05/2022]
Abstract
Konzo epidemics have occurred during droughts in the Democratic Republic of Congo (DR Congo) for >70 years, but also in Mozambique, Tanzania, and the Central African Republic. The illness is attributed to exposure to cyanide from cassava foods, on which the population depends almost exclusively during droughts. Production of cassava, a drought-resistant crop, has been shown to correlate with cyclical changes in precipitation in konzo-affected countries. Here we review the epidemiology of konzo as well as models of its pathogenesis. A spectral analysis of precipitation and konzo is performed to determine whether konzo epidemics are cyclical and whether there is spectral coherence. Time series of environmental temperature, precipitation, and konzo show cyclical changes. Periodicities of dominant frequencies in the spectra of precipitation and konzo range from 3 to 6 years in DR Congo. There is coherence of the spectra of precipitation and konzo. The magnitude squared coherence of 0.9 indicates a strong relationship between variability of climate and konzo epidemics. Thus, it appears that low precipitation phases of climate variability reduce the yield of food crops except cassava, upon which the population depends for supply of calories during droughts. Presence of very high concentrations of thiocyanate (SCN(-) ), the major metabolite of cyanide, in the bodily fluids of konzo subjects is a consequence of dietary exposure to cyanide, which follows intake of poorly processed cassava roots. Because cyanogens and minor metabolites of cyanide have not induced konzo-like illnesses, SCN(-) remains the most likely neurotoxicant of konzo. Public health control of konzo will require food and water programs during droughts. [Correction added on 26 February 2015, after first online publication: abstract reformatted per journal style]
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Makila-Mabe BG, Kikandau KJ, Sombo TM, Okitundu DL, Mwanza JC, Boivin MJ, Ngoyi MD, Muyembe JJT, Banea JP, Boss GR, Tshala-Katumbay D. Serum 8,12-iso-iPF2α-VI isoprostane marker of oxidative damage and cognition deficits in children with konzo. PLoS One 2014; 9:e107191. [PMID: 25222616 PMCID: PMC4164531 DOI: 10.1371/journal.pone.0107191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022] Open
Abstract
We sought to determine whether motor and cognitive deficits associated with cassava (food) cyanogenic poisoning were associated with high concentrations of F2-isoprostanes, well-established indicators of oxidative damage. Concentrations of serum F2-isoprostanes were quantified by LC-MS/MS and anchored to measures of motor proficiency and cognitive performance, which were respectively assessed through BOT-2 (Bruininks/Oseretsky Test, 2nd Edition) and KABC-II (Kaufman Assessment Battery for Children, 2nd edition) testing of 40 Congolese children (21 with konzo and 19 presumably healthy controls, overall mean age (SD): 9.3 (3.2) years). Exposure to cyanide was ascertained by concentrations of its main metabolite thiocyanate (SCN) in plasma and urine. Overall, SCN concentrations ranged from 91 to 325 and 172 to 1032 µmol/l in plasma and urine, respectively. Serum isoprostanes ranged from 0.1 to 0.8 (Isoprostane-III), 0.8 to 8.3 (total Isoprostane-III), 0.1 to 1.5 (Isoprostane-VI), 2.0 to 9.0 (total Isoprostane-VI), or 0.2 to 1.3 ng/ml (8,12-iso-iPF2α-VI isoprostane). Children with konzo poorly performed at the BOT-2 and KABC-II testing relative to presumably healthy children (p<0.01). Within regression models adjusting for age, gender, motor proficiency, and other biochemical variables, 8,12-iso-iPF2α-VI isoprostane was significantly associated with the overall cognitive performance (β = −32.36 (95% CI: −51.59 to −13.03; P<0.001). This model explained over 85% of variation of the KABC-II score in children with konzo, but was not significant in explaining the motor proficiency impairment. These findings suggest that cognitive deficits and, possibly, brain injury associated with cassava poisoning is mediated in part by oxidative damage in children with konzo. 8,12-iso-iPF2α-VI isoprostane appears to be a good marker of the neuropathogenic mechanisms of konzo and may be used to monitor the impact of interventional trials to prevent the neurotoxic effects of cassava cyanogenic poisoning.
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Affiliation(s)
| | - Kambale J. Kikandau
- Department of Biomedical Sciences, University of Kinshasa, Kinshasa, Congo-Kinshasa
| | - Thérèse M. Sombo
- Department of Neurology, University of Kinshasa, Kinshasa, Congo-Kinshasa
| | - Daniel L. Okitundu
- Department of Neurology, University of Kinshasa, Kinshasa, Congo-Kinshasa
| | - Jean-Claude Mwanza
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael J. Boivin
- Department of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan, United States of America
| | - Mumba D. Ngoyi
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Congo-Kinshasa
- Department of Parasitology, Institut National de Recherches Biomédicales, Kinshasa, Congo-Kinshasa
| | - Jean-Jacques T. Muyembe
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Congo-Kinshasa
- Department of Parasitology, Institut National de Recherches Biomédicales, Kinshasa, Congo-Kinshasa
| | - Jean-Pierre Banea
- Department of Nutrition, School of Public Health & National Nutrition Program, Ministry of Health, Kinshasa, Congo-Kinshasa
| | - Gerard R. Boss
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Desiré Tshala-Katumbay
- Department of Neurology, University of Kinshasa, Kinshasa, Congo-Kinshasa
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
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