Though the girls were not from the same household, or even the same village, they were related. After further exploring their history, it became clear that other children in their villages had recently begun experiencing the same ailment. At examination the spastic gait was apparent. Further neurological examination only revealed brisk reflexes at the lower extremities. The rapid malaria test for both was positive. The working diagnosis of the local MSF team was an unknown kind of vitamin-deficiency. The case subsequently was sent to the TM platform. 

The TM pediatrician in the Netherlands and the TM pediatric neurologist in the United States recognized the rare presentation and quickly responded to the team: “This is KONZO!”  Konzo means ‘tied legs’ in the Yaka language in southwestern Democratic Republic of Congo, where the first cases were described in 1938, and aptly describes the spastic gait. 

The exact cause has not been fully elucidated, but there is a close association with a high intake of cyanide from a monotonous diet of improperly prepared bitter cassava. There is no known therapy. The neurological damage is permanent, though some spontaneous improvement over weeks can be expected.  

Immediately after confirmation of the diagnosis, the team went to the villages and identified more cases. The local market was found to be the most likely source of the improperly prepared cassava.  

After relevant information and education on cassava preparation was spread via the usual local channels, no more cases were seen. Though the girls could not be helped, telemedicine played a pivotal role in preventing others from acquiring this permanent crippling affliction.

By Dr Jaap Karsten