MYELOPATHY ASSOCIATED WITH HUMAN T CELL LYMPHOTROPIC VIRUS TYPE I (HTLV-I) IN NATAL, SOUTH AFRICA

• DOI: 10.1093/brain/113.5.1307
• Publication Date: 2007-01-04T09:37:03Z
• Authors: A. I. BHIGJEE; C. KELBE; H. C. HARIBHAI; I. M. WINDSOR; M. H. HOFFMANN; G. MODI; P. L. A. BILL; W. B. BECKER; B. SINGH; S. ENGELBRECHT
• Keywords: Tropical spastic paraparesis; CSF pleocytosis; Subclinical infection; Arachnoiditis; Pleocytosis

Unexplained spastic myelopathy in black (Zulu) patients, similar to that seen the tropics, has previously been described from Natal, South Africa. Following reports linking human T cell lymphotropic virus type I (HTLV-I) myelopathy, we undertook a prospective and retrospective search for HTLV-I antibodies 36 patients who were labelled as having unexplained myelopathy; 24 (66%) positive was isolated 4 out of 6 whose peripheral blood lymphocytes cultured. Eighteen (75%) gave short history (less than months). There female preponderance (71%), spinothalamic dysfunction common (55%) many half severely disabled (50% wheelchair bound). Routine laboratory studies showed no specific trends apart hypergammaglobulinaemia CSF pleocytosis (greater 5 cells/microliter 66% patients). The total protein raised 0.4 g/l) 45% patients. IgG index greater 0.7 15 19 Conventional myelography did not show any abnormalities. Computer assisted undertaken 22 patients; 3 arachnoiditis 2 spinal cord atrophy. Periventricular lucencies 1 10 had computed tomography head. Nerve conduction demonstrated abnormalities 46% indicating subclinical nerve common. Visual evoked responses abnormal only patient but brainstem auditory response some abnormality 42% finding significant number, isolation our with noncompressive represents substantial clinical advance. Future should define more clearly role this disorder.