Mystery Epidemic In Central America: CKD

In an earlier post, I talked about some mystery diseases globally. None, however, may have affected as many people as a strange kidney disease impacting sugar cane workers in Central America. As a recent article states, the suffering in some communities in the region has been immense: “In the past 10 years, it’s believed that hundreds, if not thousands, of residents of Chichigalpa — mostly male sugarcane workers — have died from chronic kidney disease, or CKD. That in a city of nearly 60,000, roughly the size of Ames, Iowa.” One study of a farming community in El Salvador found that one quarter of men were suffering from signs of CKD. In another community, La Isla, Nicaragua, allegedly seventy percent of men have the disease.

At this point people are blaming a host of different factors for the disease: pesticides, dehydration and arsenic. Unsurprisingly, the sugar industry denies that its actions could be responsible in any way for the illness. One spokesperson told Kerry Sanders and Lisa Riordan Seville at NBC News that the root of the problem might be alcohol or volcanoes:

“`We are not responsible for it,” said Mario Amador, a spokesman for the sugarcane industry. “We’re working to find a solution.” He also blames the workers themselves, saying they drink too much alcohol. “It’s part of our culture,” Amador said. “It’s part of the things we do in our country. Poor people do it a lot.” Amador also speculated that active volcanoes in the region could have contaminated the water supply. But he admits he does not know why so many have died from CKD.'”

Strangely, one sugar cane worker said that the sugar company had blamed the workers for the illness, because they had not kept their houses sufficiently clean, as this video from Nicaragua records. What is clear is the extent to which the industry perceives that it may be legally and politically vulnerable if a link between its actions and the illness is proved.

Many researchers are now studying this topic, in part because it is killing people throughout Central America, not only in the epicenter of Nicaragua. And the issue is finally getting the media coverage that it deserves. Will Storr’s article in the Guardian is one recent example. Still, I can’t help but wonder if the current moment is not like the early moments of the HIV epidemic in that multifactorial explanations were favored, when only one underlying virus caused the condition. What is staggering is that perhaps 2,800 or more people -mostly men- are dying in the region every year from this kidney disease. And as yet, there is still no convincing explanation for why this is happening.

What is striking is not only the number of men affected, but also the geography of the disease, which has stretched down the Pacific Coast of Central America. There are many other areas in Latin America that cultivate sugar cane, have workers in substandard conditions, and where pesticides are poorly regulated. Yet Chronic Kidney Disease, CKD, seems to have only appeared in this relatively restricted range. Why? Could this be the appearance of a new infectious agent? But why would it affect only men, and mostly those in the cane fields? And if it is pesticides, why has it not appeared in other regions? And if that is the case, why are men in other physically demanding occupations -such as port workers- also coming down with the disease? Is there something distinctive about the pesticide use in this particular region? Or are the pesticides are red herring? Or are there other hypotheses for this illness which researchers are failing to see?

While there are always mystery epidemics, this one is perhaps the largest in the world today, and perhaps also the most difficult to explain. Without some understanding of what causes this illness, the epidemic seems likely to worsen. A serious global research effort in the region is now badly needed, involving the CDC, WHO and other key players. And I can’t help but wonder what some careful viral sampling might reveal.

Shawn Smallman, Portland State University