Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence

Eduard E. Zijlstra, Jaap J. van Hellemond, Arthur D. Moes, Christa de Boer, Shelley A. Boeschoten, Catharina E.M. van Blijswijk, Roos M. van der Vuurst de Vries, Peter A.B. Bailey, Sam Kampondeni, Lisette van Lieshout, Saskia L. Smits, Juri Katchanov, Nyengo M. Mkandawire, Camilla Rothe

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Nontraumatic myelopathy causes severe morbidity and is not uncommon in Africa. Clinically, patients often present with paraplegia, and extrinsic cord compression and transverse myelitis are most common causes. Data on exact pathogenesis are scanty because of limitations in diagnostic methods. In Queen Elizabeth Central Hospital, Blantyre, Malawi, we recorded consecutive patients presenting with nontraumatic paraplegia for maximally 6 months between January and July 2010 and from March to December 2011. The diagnostic workup included imaging and examining blood, stool, urine, sputum, and cerebrospinal fluid (CSF) samples for infection. After discharge, additional diagnostic tests, including screening for virus infections, borreliosis, syphilis, and schistosomiasis, were carried out in the Netherlands. The clinical diagnosis was, thus, revised in retrospect with a more accurate final differential diagnosis. Of 58 patients included, the mean age was 41 years (range, 12-83 years) and the median time between onset and presentation was 18 days (range, 0-121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (n = 24, 41%), tumors (n = 16, 28%), and transverse myelitis (n = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with Schistosoma, Treponema pallidum, Epstein-Barr virus (EBV), HHV-6, HIV, as well as a novel cyclovirus. The diagnosis of the cause of paraplegia is complex and requires access to an magnetic resonance imaging (MRI) scan and other diagnostic (molecular) tools to demonstrate infection. The major challenge is to confirm the role of detected pathogens in the pathophysiology and to design an effective and affordable diagnostic approach.

Original languageEnglish
Pages (from-to)451-457
Number of pages7
JournalThe American journal of tropical medicine and hygiene
Volume102
Issue number2
DOIs
Publication statusPublished - 1 Feb 2020

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