{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:30:27Z","timestamp":1793809827288,"version":"4.6.1"},"reference-count":23,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    In September 2023, a cluster of unexplained illness in women affecting their ability to stand\/walk was reported at Bundibugyo Hospital, Uganda. Field investigations were conducted to verify reports, conduct active case finding, and identify potential causes using a hypothesis-generating questionnaire, a neurological examination tool, and a standardized laboratory panel. As of January 31, 2025, 136 patients were identified; all were female. Among 108 with age data, the median age was 18 years old, and all but one lived in Bundibugyo District. All reported bilateral lower-extremity tremors interfering with their ability to stand\/walk that resolved when sitting or lying down. Of 75 women evaluated, 33 (44%) were acutely symptomatic at assessment. Tremors lasted between 4 days and 3 months. Of 90 women who provided symptom recurrence information, 20 (22%) reported recurrent episodes. No shared environmental exposures of concern were identified among 76 patients with data. Although limited female-specific exposures were noted, no known toxins were identified among patients. Blood specimens were submitted for laboratory testing, and 24 of 93 (26%) tested positive for\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    . One of 34 (3%) tested positive for\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp. Three of 87 (3%) were positive for Ekpoma virus 2 (EKV2), and 41 of 80 (51%) were anti-EKV2 IgG positive. Metagenomic sequencing confirmed two of the EKV2 cases and identified rickettsiae-specific reads in one individual. It is still unknown whether the cause is an infectious agent or an environmental toxin. This outbreak highlights the importance of strong field epidemiology and laboratory capacity in investigating emerging neurological syndromes.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0088","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:29:12Z","timestamp":1790090952000},"page":"977-984","source":"Crossref","is-referenced-by-count":0,"title":["Investigation of Dinga Dinga: A Cluster of Bilateral Lower-Extremity Tremors\u2014Bundibugyo District, Uganda, 2023\u20132024"],"prefix":"10.4269","volume":"115","author":[{"given":"Sophia","family":"Mulei","sequence":"first","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Orit","sequence":"additional","affiliation":[{"name":"Uganda Field Epidemiology Training Program, TEPHINET, The Task Force for Global Health, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary J.","family":"Choi","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Whitmer","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin S.","family":"Sadigh","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Baluku","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kami","family":"Smith","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Todres","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin R.","family":"Torach","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benigna","family":"Namara","sequence":"additional","affiliation":[{"name":"Uganda Field Epidemiology Training Program, TEPHINET, The Task Force for Global Health, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nanjubu","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children\u2019s Foundation Uganda, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon P.","family":"Lubega","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children\u2019s Foundation Uganda, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Baguma","sequence":"additional","affiliation":[{"name":"Bundibugyo Hospital, Bundibugyo, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Ejoku","sequence":"additional","affiliation":[{"name":"Bundibugyo Hospital, Bundibugyo, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens H.","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Division of Clinical Research (DCR), Integrated Research Facility at Fort Detrick (IRF-Frederick), National Institute of Allergy and Infectious Diseases (NIH\/NIAID), Frederick, Maryland, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuiqing","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Clinical Research (DCR), Integrated Research Facility at Fort Detrick (IRF-Frederick), National Institute of Allergy and Infectious Diseases (NIH\/NIAID), Frederick, Maryland, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandor","family":"Karpathy","sequence":"additional","affiliation":[{"name":"Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Picornavirus Lab, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry Fei Fan","family":"Ng","sequence":"additional","affiliation":[{"name":"Picornavirus Lab, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sejvar","sequence":"additional","affiliation":[{"name":"Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Shoemaker","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel M.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Lutwama","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kadobera","sequence":"additional","affiliation":[{"name":"Uganda Field Epidemiology Training Program, TEPHINET, The Task Force for Global Health, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kiyita","sequence":"additional","affiliation":[{"name":"Bundibugyo District Health Office, Bundibugyo, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Mwebesa","sequence":"additional","affiliation":[{"name":"Uganda Ministry of Health, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Nyakarahuka","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"},{"name":"Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Balinandi","sequence":"additional","affiliation":[{"name":"Uganda Virus Research Institute, Entebbe, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Klena","sequence":"additional","affiliation":[{"name":"Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Infect Dis","first-page":"S761","article-title":"Filovirus outbreak detection and surveillance: Lessons from Bundibugyo","volume":"204","author":"MacNeil","year":"2011"},{"key":"b2","series-title":"Lancet Neurol","first-page":"344","article-title":"Global, regional, and national burden of disorders affecting the nervous system, 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