Myelopathy Associated With Human T Cell Lymphotropic Virus Type I (Htlv-I) in Natal, South Africa

Abstract

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

NEUROLOGICAL ASPECTS OF TROPICAL DISEASE: HTLV-1 and HIV infections of the central nervous system in tropical areas

“…68 73 74Other common symptoms are painful legs, paraesthesias, back pain, and bladder dysfunction. The most common neurological sign is a spastic paraparesis which is asymmetric in one third of patients.…”

Sensory Dysfunction in HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis

“…Sugimura et al [22]reported a slight decrease in myelinated fiber density in the sural nerves of 3 HAM/TSP patients. Bhigjee et al [23]reported mild electrophysiological signs of peripheral nerve dysfunction in 7 out of 15 patients and a decrease in myelinated fibers in the sural nerves in 4 out of 6 patients with these mild abnormalities [10]. Said et al [21]and Bhigjee et al [23]postulated that the peripheral nervous system impairment could be part of the pathological spectrum of the involvement of the nervous system by HTLV-I.…”

“…Bhigjee et al [23]reported mild electrophysiological signs of peripheral nerve dysfunction in 7 out of 15 patients and a decrease in myelinated fibers in the sural nerves in 4 out of 6 patients with these mild abnormalities [10]. Said et al [21]and Bhigjee et al [23]postulated that the peripheral nervous system impairment could be part of the pathological spectrum of the involvement of the nervous system by HTLV-I. Considering the small number of cases described and the nonprospective design of these studies, it is possible that the peripheral involvement described is only a fortuitous finding due to other unidentified associated pathology.…”

Tropical Neurology

“…While the virus is detected in the spinal cord, much of the damage is thought to be immune-mediated. 49 HAM/TSP appears more often among females between 30 and 60 years as a subacute, progressive paraparesis with variable sensory disturbance and bladder dysfunction. Spasticity is present in all and weakness (96%), bladder dysfunction (80%), backache (60%), numbness or paraesthesiae (66%) and bowel dysfunction (47%) occur in descending frequency.…”