title: AIDS-related progressive multifocal leukoencephalopathy (PML): a retrospective study from Pretoria, South Africa.
abstract: OBJECTIVE
  Progressive multifocal leukoencephalopathy (PML), caused by the John Cunningham (JC) virus, results from lytic infection of predominantly oligodendrocytes. Following the HIV pandemic, the incidence of PML has risen sharply, but has rarely been reported in Africa. An increasing number of PML cases were seen recently in a tertiary South African hospital, and this study describes their clinical and radiological features.
  
  
  METHODS
  Patients with positive cerebrospinal fluid (CSF) JC virus confirmed by real-time polymerase chain reaction (PCR) were retrospectively identified from January 2008 to June 2012. Adults seen at Neurology with PML were identified, and clinical features, laboratory findings and imaging studies were analysed.
  
  
  RESULTS
  Of 121 specimens, 19 were positive; records of 17 patients were available (ages 27 - 64; CD4 counts 11 - 328 x106/μl); clinical manifestations included focal weakness (47%), impaired co-ordination (41%), and speech disturbances (12%), and CSF analysis showed high protein in 76%, and pleocytosis in 35%. Fifteen patients had CT brain scans, showing white matter involvement in 12; MRI studies in 13 patients showed typical PML lesions.
  
  
  CONCLUSIONS
  This report is the first case series of patients with PML from a South African neurology unit, emphasising the fact that PML occurs commonly in South African patients with HIV infection.
authors.affiliation: Department of Neurology, University of Pretoria, Pretoria, South Africa. cschutte@medic.up.ac.za
authors.forename: C-M
authors.initials: CM
authors.lastname: Schutte
authors.forename: N
authors.initials: N
authors.lastname: Ranchhod
authors.forename: M
authors.initials: M
authors.lastname: Kakaza
authors.forename: M
authors.initials: M
authors.lastname: Pillay
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D000328:Adult; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology