An Epidemiologic Investigation of Potential Risk Factors for Nodding Syndrome in Kitgum District, Uganda.
An Epidemiologic Investigation of Potential Risk Factors for Nodding Syndrome in Kitgum District, Uganda.
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DOI：
10.1371/journal.pone.0066419
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Lwamafa DK
中科院分区：
文献类型：
--
作者：
Foltz JL;Makumbi I;Sejvar JJ;Malimbo M;Ndyomugyenyi R;Atai-Omoruto AD;Alexander LN;Abang B;Melstrom P;Kakooza AM;Olara D;Downing RG;Nutman TB;Dowell SF;Lwamafa DK
点头综合症（NS）是一种无法解释的疾病，其特征是头部反复摆动，早在1962年就在苏丹和坦桑尼亚有报道。假设的病因包括食用高粱、麻疹和盘尾丝虫病感染。2009年，据报道在乌干达北部发生了几千起病例。2009年12月，我们在基特古姆区发现了病例。病例定义包括以前发育正常但有点头的人。进一步定义为5至15岁伴有额外神经功能缺陷的病例与村庄对照进行匹配，以评估风险因素并检测生物标本。使用逻辑回归模型来评估相关性。监测发现224例；大多数（95%）为5- 15岁（范围为2-27岁）。乌干达自1997年以来报告了病例。总患病率为每1000例12例（教区范围= 0.6 - 46）。病例-对照调查（n = 49对病例/村对照）显示，NS与以前报告的麻疹之间没有关联；大多数被试都食用高粱。盘尾丝虫病血清学阳性[年龄校正比值比(AOR1) = 14.4(2·7,78·3)]、暴露于弹药[AOR1 = 13.9(1·4,135·3)]和食用碎根[AOR1 = 5·4(1·3,22·1)]更为常见。大多数病例（84%）和对照组（75%）存在维生素B6缺乏症。自2000年以来，乌干达的NS似乎有所增加，2009年教区患病率高达每1,000名5至15岁儿童46例。我们的研究结果没有发现许多提出的NS危险因素的支持证据，揭示了与盘尾丝虫病的关联，这是第一次通过血清学检测进行检查，并提出营养缺乏和有毒暴露可能是病因。
Nodding Syndrome (NS), an unexplained illness characterized by spells of head bobbing, has been reported in Sudan and Tanzania, perhaps as early as 1962. Hypothesized causes include sorghum consumption, measles, and onchocerciasis infection. In 2009, a couple thousand cases were reportedly in Northern Uganda. In December 2009, we identified cases in Kitgum District. The case definition included persons who were previously developmentally normal who had nodding. Cases, further defined as 5- to 15-years-old with an additional neurological deficit, were matched to village controls to assess risk factors and test biological specimens. Logistic regression models were used to evaluate associations. Surveillance identified 224 cases; most (95%) were 5–15-years-old (range = 2–27). Cases were reported in Uganda since 1997. The overall prevalence was 12 cases per 1,000 (range by parish = 0·6–46). The case-control investigation (n = 49 case/village control pairs) showed no association between NS and previously reported measles; sorghum was consumed by most subjects. Positive onchocerciasis serology [age-adjusted odds ratio (AOR1) = 14·4 (2·7, 78·3)], exposure to munitions [AOR1 = 13·9 (1·4, 135·3)], and consumption of crushed roots [AOR1 = 5·4 (1·3, 22·1)] were more likely in cases. Vitamin B6 deficiency was present in the majority of cases (84%) and controls (75%). NS appears to be increasing in Uganda since 2000 with 2009 parish prevalence as high as 46 cases per 1,000 5- to 15-year old children. Our results found no supporting evidence for many proposed NS risk factors, revealed association with onchocerciasis, which for the first time was examined with serologic testing, and raised nutritional deficiencies and toxic exposures as possible etiologies.
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