A mysterious kidney disease is striking Central America’s sugarcane heartland, and experts believe it could become the next big Latino health epidemic, The New York Times reports.

The painful illness—currently referred to by some as chronic kidney disease of unknown causes, or CKDu—has killed at least 20,000 people in Latin America during the past decade.

CKDu, which largely affects young male workers in the region’s sugarcane plantations, causes seemingly healthy men to waste away in a short amount of time. Early symptoms include lethargy, fever, problems with coordination and extreme weight loss. In certain regions it is estimated that one in three sugar cane workers have the disease.

Theories of CKDu’s causes vary drastically among health experts, ranging from heat stress and chronic dehydration to toxic chemicals, sugar consumption and even volcanic ash. However, the only research done on the illness so far has been conducted entirely by the sugar industry, shrouding the investigations in a veil of conspiracy theories and skepticism.

In response to the emerging epidemic, the U.S. Centers for Disease Control and Prevention (CDC) is conducting a large-scale study of CKDu across Central America. The CDC will be focusing on agrochemicals, genetic factors, climate change and the disease’s prevalence in children.

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