Dissertations & Theses (Open Access)

Date of Award

Fall 12-2018

Degree Name

Master of Science in Public Health (MSPH)


Catherine Troisi, Phd

Second Advisor

Rebecca Fischer, Phd

Third Advisor

Ruosha Li, Phd


Throughout Latin America, an epidemic of a kidney disease of an unknown etiology has been occurring since the late 1990s, and this disease is being called “Mesoamerican nephropathy.” Mesoamerican nephropathy predominantly affects male sugarcane workers. In Chichigalpa, Chinandega, Nicaragua, there is sugarcane plantation that is being heavily impacted by the Mesoamerican nephropathy epidemic, and they invited researchers from Baylor College of Medicine to investigate the epidemic. The prospective epidemic investigation began in 2015, and it is an ongoing investigation. Based on the compilation of data collected during the preliminary investigation, our hypothesis is that a possible zoonotic disease, such as hantavirus and/or Leptospira, could be causing Mesoamerican Nephropathy due to the large rodent population in the fields. Our specific aims were to determine the prevalence of hantavirus and Leptospira among the study population and to describe and evaluate the differences between potential risk factors for MeN. We tested for IgM and IgG antibodies using ELISA kits for hantavirus and Leptospira. For hantavirus, we tested 149 cases and 50 controls. Due to kit validation issues, we tested 92 controls for Leptospira IgM and IgG antibodies, and we tested 104 cases for Leptospira IgM antibodies and 45 cases for Leptospira IgG antibodies. We also built a multivariate logistic model using the purposeful model selection method to evaluate potential risk factors for the disease. The model was tested for goodness of fit and validated. We found that hantavirus had an overall prevalence of 12.1% and Leptospira had 27% prevalence for IgM antibodies with 1.5% for IgG antibodies. Hantavirus and Leptospira were not statistically found to be probable causes for the epidemic. The results from the multivariate model found that the use of some types of protective equipment and access to safe drinking water help to reduce the odds of disease. Having an immediate family member also increases the odds. While the results of this study allow us to eliminate hantavirus and Leptospira, it does not eliminate a possible zoonotic pathogen. Implementing the use of protective equipment and providing access to safe drinking water may be possible prevention strategies. Continued investigation is needed to determine the etiology of the epidemic.