Case-Control Study of Nodding Syndrome in Acholiland: Urinary Multi-Mycotoxin Screening

Area of Science:

• Environmental Health
• Pediatric Neurology
• Toxicology

Background:

• Nodding Syndrome (NS) is a childhood seizure disorder prevalent in northern Uganda.
• Previous studies suggested links between NS and measles, emergency food reliance, and consumption of moldy maize.
• Moldy maize is a potential source of mycotoxins, which are toxic metabolites produced by fungi.

Purpose of the Study:

• To investigate current mycotoxin exposure in children with Nodding Syndrome (NS) and community controls (CC) in northern Uganda.
• To determine if specific mycotoxin loads differ between NS cases and CC.
• To assess the prevalence of common foodborne mycotoxins in the study population.

Main Methods:

• A case-control study involving 50 NS cases and 50 age- and gender-matched CC.
• Urine samples were analyzed using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).
• Nine mycotoxin analytes were screened, with a focus on α-zearalenol, T-2 toxin, and aflatoxin M1.

Main Results:

• No significant difference in the presence of three detected mycotoxins (α-zearalenol, T-2 toxin, aflatoxin M1) between NS cases and CC.
• Ninety-five percent of all samples contained at least one urinary mycotoxin.
• Eighty-seven percent of samples were positive for two of the three detected mycotoxins, indicating widespread exposure.
• Detected mycotoxins included those commonly associated with maize consumption.

Conclusions:

• Children in this Ugandan community, both with and without Nodding Syndrome, are currently exposed to foodborne mycotoxins.
• The study highlights a potential common environmental exposure, possibly linked to maize consumption, affecting children regardless of NS status.
• Further research is needed to understand the long-term implications of mycotoxin exposure in relation to NS pathogenesis.