The presymptomatic phase of kuru lasts, on average, 10 to 13 years but incubation time can range from 5 years to 50 years (Collinge et al., 2008). The mean clinical duration of the disease is 12 months but may be as short as 3 months, as long as 2 years, or even longer in some atypical cases (Collinge et al., 2008). Kuru infection progresses through three general stages: ambulatory, sedentary, and terminal (Alpers, 2005). Throughout all of these stages, the primary physiological symptom of the disease is progressive cerebellar ataxia (Gajdusek, 1957). In the ambulatory stage, patients demonstrate involuntary tremors, and a lack of coordination, though they are still capable of speaking and moving themselves around (Gajdusek, 1957). In the sedentary stage, an infected individual shows strong ataxia, they cannot move around without assistance, show major dysarthria, and are prone to excessive bursts of laughter (Gajdusek, 1957). At the terminal stage, infected individuals can no longer sit without support, speech is completely lost, urinary and fecal incontinence appear, dysphagia occurs and eventually, many develop ulcerated wounds that are prone to infection (Gajdusek, 1957). Death occurs shortly thereafter either due to wound infection or terminal static bronchopneumonia (Gajdusek, 1957).
At the neuropathological level, kuru shows similar features to other diseases caused by prions. PrPSC accumulates in grey matter regions throughout the cerebrum, cerebellum, brainstem, and spinal cord, leading to an atrophied brain overall (Hainfellner et al., 1997). PrPSC deposits in two ways: fine, granular deposits that occur perineuronally and periaxonally, and in dense plates with a homogeneous centre surrounded by radiating spikes (Hainfellner et al., 1997). Though PrPSC aggregates resist proteolysis, they are relatively inert. The danger comes as they self-propagate because they create a byproduct called PrPL that is neurotoxic and is directly responsible for neurodegeneration (Collinge & Clarke, 2007). This neurodegeneration presents itself, in part, as fibrillary astrogliosis most apparent in the parasagittal and interhemispheric areas of the frontal, central, and parietal cortex, as well as the cingulate cortex, striatum, and thalamus (Hainfellner et al., 1997). Loss of neurons due to PrPSC accumulation is most prominent in the: dorsomedial frontal cortex, dorsomedial central cortex, pre/parasubiculum of the hippocampus, striatum, thalamus, and inferior olivary nuclei of the medulla (Hainfellner et al., 1997). Though less severely, some PrPSC plates introgress into the white matter of both the cerebrum and the cerebellum (Hainfellner et al., 1997). The brainstem suffers from some neurodegeneration and astrogliosis caused by periaxonal and perineuronal PrPSC deposits rather than plaques (Hainfellner et al., 1997). Lastly, there are accentuated periaxonal and perineuronal PrPSC aggregates in the substantia gelatinosa of the spinal cord (Hainfellner et al., 1997).
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