Cuban neuromyelopathy epidemic

ABSTRACT

During the last semester of 1991 an unexpected increase in the number of cases of optic neuropathy was detected by the Cuban Epidemiological Surveillance System in the Pina del Rio province of Western Cuba. Reported cases occurred mainly in middle-aged men, usually tobacco farmers with a history of cigarette smoking and moderate alcohol consumption. Patients complained of weight loss, blurred vision, photophobia, and progressive decrease in visual acuity over a period of 1-4 weeks. Examination disclosed the presence of bilateral and usually symmetrical central or cecocentral visual field defects with the loss of red-green colour vision, pallor of temporal border of optic disc and loss of fibres in maculopapillary bundle. A diagnosis of tobacco-alcohol amblyopia or nutritional optic neuropathy was made at the time. By the end of July 1992, a total of 168 cases had been reported (monthly range, 14-36), all confirmed to this province. By December 1992, the number had increases to 472 cases, including reports from five of fourteen provinces of Cuba, mainly in Havana, Sancti Spiritus, Holguin and Santiago de Cuba (AU)