Document Detail


Myelopathy associated with human T cell lymphotropic virus type I (HTLV-I) in natal, South Africa. A clinical and investigative study in 24 patients.
MedLine Citation:
PMID:  2245298     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A I Bhigjee; C Kelbe; H C Haribhai; I M Windsor; M H Hoffmann; G Modi; P L Bill; W B Becker; B Singh; S Engelbrecht
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Brain : a journal of neurology     Volume:  113 ( Pt 5)     ISSN:  0006-8950     ISO Abbreviation:  Brain     Publication Date:  1990 Oct 
Date Detail:
Created Date:  1991-01-10     Completed Date:  1991-01-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372537     Medline TA:  Brain     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1307-20     Citation Subset:  AIM; IM; X    
Affiliation:
Department of Medicine, Faculty of Medicine, University of Natal, South Africa.
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MeSH Terms
Descriptor/Qualifier:
Blotting, Western
Electrophysiology
Evoked Potentials
Female
HTLV-I Antibodies / analysis*
Humans
Male
Nervous System / physiopathology
Neural Conduction
South Africa
Spinal Cord Diseases / immunology*,  physiopathology
Spine / radiography
Chemical
Reg. No./Substance:
0/HTLV-I Antibodies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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