title: Myelopathy associated with human T cell lymphotropic virus type I (HTLV-I) in natal, South Africa. A clinical and investigative study in 24 patients.
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.
authors: Department of Medicine, Faculty of Medicine, University of Natal, South Africa.
authors: A I
authors: AI
authors: Bhigjee
authors: C
authors: C
authors: Kelbe
authors: H C
authors: HC
authors: Haribhai
authors: I M
authors: IM
authors: Windsor
authors: M H
authors: MH
authors: Hoffmann
authors: G
authors: G
authors: Modi
authors: P L
authors: PL
authors: Bill
authors: W B
authors: WB
authors: Becker
authors: B
authors: B
authors: Singh
authors: S
authors: S
authors: Engelbrecht
mesh_terms: D015153:Blotting, Western; D004594:Electrophysiology; D005071:Evoked Potentials; D005260:Female; D015481:HTLV-I Antibodies / Q000032:analysis*; D006801:Humans; D008297:Male; D009420:Nervous System / Q000503:physiopathology; D009431:Neural Conduction; D011859:Radiography; D013019:South Africa; D013118:Spinal Cord Diseases / Q000276:immunology* / Q000503:physiopathology; D013131:Spine / Q000000981:diagnostic imaging
chemical_list: D015481:HTLV-I Antibodies