Volume 19, Number 9—September 2013
Synopsis
Nodding Syndrome
Table 5
Possible causes of nodding syndrome, by infectious and postinfectious findings*
Possible cause by category | Investigation (reference) | Negative findings | Positive findings |
---|---|---|---|
Infectious encephalitis | |||
Malaria | Foltz et al., Uganda (6) | Blood smear (98% case-patients vs. 95% controls) | None |
Trypanosomiasis | Foltz et al., Uganda (6) | Seronegative (36 patients tested) | None |
Tumwine et al., Sudan (2) | Seronegative (69 patients tested) | None | |
Cysticercosis | Foltz et al., Uganda (6) | Seronegative (36 patients tested); cysts absent by MRI (5 patients tested) | None |
Prion disease | Sejvar et al., Uganda (7) | EEG and MRI results and clinical course not compatible | None |
Winkler et al., Tanzania (9) | EEG and MRI results and clinical course not compatible | None | |
Onchocerciasis | Tumwine et al., Sudan, 2001 investigation (2) | None | Skin snip specimens for 93% of patients vs. 63% in controls; p<0.001 |
Tumwine et al., Sudan, 2002 investigation (2) | None | Skin snip specimens for 93% of patients vs. 44% of controls; p<0.008 | |
Winkler et al., Tanzania (9) | 48 CSF samples PCR negative for Onchocerca volvulus microfilariae | Microfilariae in skin correlated with lesions by MRI; p = 0.02 | |
Foltz et al., Uganda (6) | None | Antibody in 95% of patients vs. 49% of controls; p<0.001 | |
Riek et al., Sudan (8) | None | Skin snip in 76% of patients vs. 47% of controls; p = 0.02 | |
Other microfilarial disease | Tumwine et al., Sudan, 2001 investigation (2) | None | Mansonella perstans nematodes in 52% of patients vs. 31% of controls; p = 0.005 |
Tumwine et al,, Sudan, 2001 investigation (2) | Blood sample for Loa loa microfilariae (69 patients tested) | None | |
Tumwine et al., Sudan, 2001 investigation (2) | Lymphatic filariasis by ICT ( 26 patients tested) | None | |
Unpub. data, Uganda | None | 2 skin snip DNA sequences similar to those of Mansonella spp. nematodes | |
Unknown pathogens |
Unpub. data, Uganda |
42 serum samples and 16 CSF specimens by broadly reactive PCRs for 19 virus families |
None |
Para/postinfectious encephalopathy | |||
Measles (SSPE like) | Foltz et al., Uganda (6) | No epidemiologic association for 16 CSF samples by PCR | None |
Acute disseminated encephalomyelitis | Sejvar et al., Uganda (7) | Brain MRI (5 patients) | None |
Winkler et al., Tanzania (9) | Brain MRI (12 patients) | None | |
Poststreptococcal (Sydenham chorea-like) | Sejvar et al., Uganda (7) | No movement disorders | None |
Neuronal antibodies | Unpub. data (Mayo Clinic, Rochester, MN, USA), Uganda | 12 CSF samples for known neuronal antibodies | None |
Unpub. data (Emory University, Atlanta, GA, USA), Uganda | 3 CSF samples for neuronal antibodies by in situ hybridization with rat brain slices and human brain homogenate | None | |
Hepatitis E | Foltz et al., Uganda (6) | Seronegative (52% case-patients vs. 58% controls) | None |
*EEG, electroencephalography; MRI, magnetic resonance imaging CSF, cerebrospinal fluid; ICT, immunochromatographic test; SSPE, subacute sclerosing panencephalitis.
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