title: Progressive multifocal leukoencephalopathy and JC virus genotypes in West African patients with acquired immunodeficiency syndrome: a pathologic and DNA sequence analysis of 4 cases.
abstract: OBJECTIVE
  Progressive multifocal leukoencephalopathy is caused by polyomavirus JC in immunosuppressed patients. JC virus genotypes are identified by sequence analysis of the viral genome. Despite the prevalence of acquired immunodeficiency syndrome in sub-Saharan Africa, few cases of progressive multifocal leukoencephalopathy have been reported from this region. Here we describe 4 African cases and provide an analysis of viral genotypes.
  
  
  METHODS
  Immunohistochemical staining by labeled streptavidin-biotin for capsid protein antigen was performed on all cases. Polymerase chain reaction amplification of viral genomic DNA was followed by direct cycle sequencing.
  
  
  RESULTS
  JC virus type 3 was identified in 2 cases, and type 6 was isolated in 1 case. The viral regulatory region from 1 case showed an uncommon rearrangement pattern.
  
  
  CONCLUSIONS
  Progressive multifocal leukoencephalopathy in West African patients with acquired immunodeficiency syndrome is caused by African genotypes of JC virus (types 3 and 6). The prevalence of disease in this autopsy series from sub-Saharan Africa (1.5%) was less than has been reported from Europe and the United States (4% to 10%) and may be partly due to biological differences in JC virus genotypes. Further studies will be needed to confirm this observation.
authors.affiliation: Neurotoxicology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-4126, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Chima
authors.forename: H T
authors.initials: HT
authors.lastname: Agostini
authors.forename: C F
authors.initials: CF
authors.lastname: Ryschkewitsch
authors.forename: S B
authors.initials: SB
authors.lastname: Lucas
authors.forename: G L
authors.initials: GL
authors.lastname: Stoner
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000235:genetics*; D000328:Adult; D000349:Africa; D001483:Base Sequence; D001921:Brain / Q000473:pathology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D006801:Humans; D007150:Immunohistochemistry; D007577:JC Virus / Q000235:genetics*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000235:genetics* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic
chemical_list: D004279:DNA, Viral