Outbreak of Optic and Peripheral Neuropathy in Cuba

Since October 1991, nearly 51,000 Cubans have been diagnosed with optic neuropathy, peripheral neuropathy, or both (1,2). The onset of this disorder followed shortly after the collapse of the Soviet Union and subsequent stricter food rationing in Cuba. The clinical features resemble those of Strachan's disease (3); a disorder hypothesized to result from nutritional deficiencies (4). The disorder was described by Dr. Henry Strachan in 1888 and later named by Dr. C. Miller-Fisher. "The term Strachan's disease is suggested for the relatively clearly-defmed nutritional neuropathy and associated mucccutaneous changes exhibited by the Far East prisoners-of-war. The neurological picture comprises burning feet, numbness of the feet, hands and face, sensory ataxia, visual failure, loss of reflexes, impaired sensation and occasional spasticity." (4) Because of etiology of the Cuban outbreak was unclear, multiple pathogenic factors were considered including: nutritional deficiencies, toxins, infectious agents, and gene c susceptibility. The magnitude of this public health problem in Cuba has generated great interest in the medical and scientific communities.