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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: 2] [Impact Index Per Article: 0.7] [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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Ubwa ST, Otache MA, Igbum GO, Shambe T. Determination of Cyanide Content in Three Sweet Cassava Cultivars in Three Local Government Areas of Benue State, Nigeria. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/fns.2015.612112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kang HI, Shin HS. Derivatization Method of Free Cyanide Including Cyanogen Chloride for the Sensitive Analysis of Cyanide in Chlorinated Drinking Water by Liquid Chromatography-Tandem Mass Spectrometry. Anal Chem 2014; 87:975-81. [DOI: 10.1021/ac503401r] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hye-In Kang
- Department of Environmental
Science and ‡Department of Environmental Education, Kongju National University, Kongju, Chungcheong 314-701, Republic of Korea
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Kang HI, Shin HS. Ultra-sensitive determination of cyanide in surface water by gas chromatography-tandem mass spectrometry after derivatization with 2-(dimethylamino)ethanethiol. Anal Chim Acta 2014; 852:168-73. [PMID: 25441894 DOI: 10.1016/j.aca.2014.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/09/2014] [Accepted: 09/21/2014] [Indexed: 12/12/2022]
Abstract
A gas chromatography-tandem mass spectrometric (GC-MS/MS) method has been established for the determination of cyanide in surface water. This method is based on the derivatization of cyanide with 2-(dimethylamino)ethanethiol in surface water. The following optimum reaction conditions were established: reagent dosage, 0.7 g L(-1) of 2-(dimethylamino)ethanethiol; pH 6; reaction carried out for 20 min at 60°C. The organic derivative was extracted with 3 mL of ethyl acetate, and then measured by using GC-MS/MS. Under the established conditions, the detection and quantification limits were 0.02 μg L(-1) and 0.07 μg L(-1) in 10-mL of surface water, respectively. The calibration curve had a linear relationship relationship with y=0.7140x+0.1997 and r(2)=0.9963 (for a working range of 0.07-10 μg L(-1)) and the accuracy was in a range of 98-102%; the precision of the assay was less than 7% in surface water. The common ions Cl(-), F(-), Br(-), NO3(-), SO4(2-), PO4(3-), K(+), Na(+), NH4(+), Ca(2+), Mg(2+), Ba(2+), Mn(4+), Mn(2+), Fe(3+), Fe(2+) and sea water did not interfere in cyanide detection, even when present in 1000-fold excess over the species. Cyanide was detected in a concentration range of 0.07-0.11 μg L(-1) in 6 of 10 surface water samples.
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Affiliation(s)
- Hye-In Kang
- Department of Environmental Science, Kongju National University, Kongju 314-701, Republic of Korea
| | - Ho-Sang Shin
- Department of Environmental Education, Kongju National University, Kongju 314-701, Republic of Korea.
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van Heijst AN, Maes RA, Mtanda AT, Chuwa LM, Rwiza HT, Moshi NH. Chronic cyanide poisoning in relation to blindness and tropical neuropathy. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1994; 32:549-56. [PMID: 7932914 DOI: 10.3109/15563659409011059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Within a group of 20 patients showing optic atrophy and macula degeneration, 14 patients could be examined for neurological and audiometric defects. In 6 patients neurological signs and symptoms were observed. Nine patients reported loss of hearing and in 3 of them a severe perceptive deafness was seen in the audiogram. In 3 of the 14 patients a combination of severe neurologic and audiologic symptoms developed and in two of them a high thiocyanate concentration in serum was observed. The occurrence of perceptive deafness and posterior column sensory loss in the lower extremities in four of the patients made the diagnosis of polyneuropathy the most plausible. Although a similarity to chronic myelopathies caused by nutritional cyanide poisoning cannot be denied, the mean thiocyanate concentration in plasma 24 mumol/L (1.39 mg/L), and the cyanide levels in the blood 0.09 mumol/L (2.3 micrograms/L) were substantially lower than those found in other individuals during periods of extreme drought in which food only consisted of the bitter variety of cassava. The role of cyanide in the etiopathology of this polyneuropathy is unknown.
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Rodgers-Johnson P, Morgan OS, Mora C, Sarin P, Ceroni M, Piccardo P, Garruto RM, Gibbs CJ, Gajdusek DC. The role of HTLV-I in tropical spastic paraparesis in Jamaica. Ann Neurol 1988; 23 Suppl:S121-6. [PMID: 2894801 DOI: 10.1002/ana.410230729] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report clinical and laboratory investigations of 47 native-born Jamaican patients with endemic tropical spastic paraparesis and of 1 patient with tropical ataxic neuropathy. Mean age at onset was 40 years, with a female-male preponderance (2.7:1). Neurological features of endemic tropical spastic paraparesis are predominantly those of a spastic paraparesis with variable degrees of proprioceptive and/or superficial sensory impairment. Using enzyme-linked immunoabsorbent assay (ELISA), IgG antibodies to human T-lymphotropic virus type I (HTLV-I) were present in 82% of sera and 77% of cerebrospinal fluids. On Western blot analysis, IgG antibodies detected the p19 and p24 gag-encoded core proteins in both serum and cerebrospinal fluid. Titers were tenfold higher by ELISA in serum than in cerebrospinal fluid, and some oligoclonal bands present in fluid were not seen in serum. Serum-cerebrospinal fluid albumin ratios were normal, and IgG indexes indicated intrathecal IgG synthesis. Histopathological changes showed a chronic inflammatory reaction with mononuclear cell infiltration, perivascular cuffing, and demyelination that was predominant in the lateral columns. In 1 patient, a retrovirus morphologically similar to HTLV-I on electron microscopy was isolated from spinal fluid. Our investigations show that endemic tropical spastic paraparesis in Jamaica is a retrovirus-associated myelopathy and that HTLV-I or an antigenically similar retrovirus is the causal agent.
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Affiliation(s)
- P Rodgers-Johnson
- Laboratory of Central Nervous System Studies, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD 20892
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Cliff J, Lundqvist P, Mårtensson J, Rosling H, Sörbo B. Association of high cyanide and low sulphur intake in cassava-induced spastic paraparesis. Lancet 1985; 2:1211-3. [PMID: 2866292 DOI: 10.1016/s0140-6736(85)90742-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Urinary excretion of sulphur compounds was studied in children from a population in Mozambique that had been affected, during a drought, by an epidemic of spastic paraparesis attributed to cyanide exposure from cassava. The children had increased thiocyanate and decreased inorganic sulphate excretion, indicating high cyanide and low sulphur-containing amino-acid intake. Children from a neighbouring cassava-eating area, where no cases of spastic paraparesis had occurred, had lower thiocyanate excretion but higher inorganic sulphate excretion. These results support the hypothesis that the epidemic was due to the combined effects of high dietary cyanide exposure and sulphur deficiency.
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Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide intoxication in a cassava staple area of Mozambique. 1. Epidemiology and clinical and laboratory findings in patients. Ministry of Health, Mozambique. Bull World Health Organ 1984; 62:477-84. [PMID: 6331909 PMCID: PMC2536324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Investigation of an epidemic of more than 1000 cases of spastic paraparesis in a drought-striken cassava staple area of Mozambique strongly suggests an association between this disease (called mantakassa), chronic cyanide intoxication, and cassava consumption. In previous reports of neurological disease with similar associations, the disease affected an older age group with usually a gradual onset, and the predominant clinical feature was an ataxic neuropathy. In mantakassa the onset was acute, and mostly women of reproductive age and children were affected. Serum thiocyanate levels in these patients were much higher than previously reported; while spastic paraparesis of unknown etiology occurs in many tropical countries, it has not previously been linked with raised thiocyanate levels. The present evidence linking cassava consumption to the disease is circumstantial, and dietary deficiency is also probably involved. Cassava is an important food crop and a major source of energy for people in many parts of the world. In these areas, when there is a shortage of food production, e.g., during a drought, the inhabitants may be exposed to the risk of dietary cyanide intoxication. Further research is needed on the causes of mantakassa so that a repetition of this disaster could be prevented.
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Philbrick DJ, Hopkins JB, Hill DC, Alexander JC, Thomson RG. Effects of prolonged cyanide and thiocyanate feeding in rats. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1979; 5:579-92. [PMID: 490674 DOI: 10.1080/15287397909529770] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Male weaning rats were fed a semipurified diet containing 10% casein; this diet restricted in methionine, vitamin B12, and iodine; or the complete and restricted diets supplemented with either 1500 ppm potassium cyanide or 2240 ppm potassium thiocyanate for 11.5 mo. There were no deaths or clinical signs of toxicity. Cyanide, but not thiocyanate, caused a consistent reduction in weight gain in the complete and restricted groups. Both cyanide and thiocyanate caused decreased thyroid gland activity in young rats, particularly in the restricted groups. Plasma thyroxine concentrations were maintained in the mature cyanide-treated rats, even though secretion rates were decreased. However, the mature thiocyanate-treated animals showed decreased plasma thyroxine concentrations, despite thyroid gland enlargement. Modest primary myelin degeneration in the spinal cord white matter was found in the restricted group and in rats receiving this diet supplemented with either cyanide or thiocyanate. The lesions did not resemble those of a vitamin B12 deficiency in appearance or those of acute cyanide intoxication in distribution. Because of tissue autolysis, it could not be determined whether these changes resulted from histotoxic anoxia or an alteration of oligodendroglial myelin metabolism.
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Osuntokun BO, Langman MJ, Wilson J, Adeuja AO. Controlled trial of combinations of hydroxocobalamin-cystine and riboflavine-cystine, in Nigerian ataxic neuropathy. J Neurol Neurosurg Psychiatry 1974; 37:102-4. [PMID: 4360398 PMCID: PMC494569 DOI: 10.1136/jnnp.37.1.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chronic cyanide intoxication of dietary origin and riboflavine deficiency are believed to be major aetiological factors in Nigerian tropical ataxic neuropathy. The results are presented of a double-blind controlled therapeutic trial of combinations of large doses of hydroxocobalamin and cystine as cyanide binding agents together with riboflavine or placebos in Nigerian patients suffering from the tropical ataxic neuropathy. No clinical benefit was demonstrable with any of the treatments.
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