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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
AIDS-related progressive multifocal leukoencephalopathy (PML): a retrospective study from Pretoria, South Africa
C-M Schutte1, N Ranchhod, M Kakaza
1Department of Neurology, University of Pretoria, Pretoria, South Africa. cschutte@medic.up.ac.za
Introduction And Objectives:
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.
Conclusion:
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.
Insights
Progressive multifocal leukoencephalopathy (PML) is increasingly diagnosed in South African HIV patients. This study details the clinical and radiological features of PML in this population.
Area of Science:
- Neuroscience
- Infectious Diseases
- Virology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic demyelinating disease caused by the John Cunningham (JC) virus.
- PML incidence increased significantly after the HIV pandemic, yet reports from Africa remain scarce.
- Recent observations indicated a rise in PML cases at a South African tertiary hospital.
Purpose of the Study:
- To describe the clinical and radiological characteristics of PML in South African patients.
- To highlight the occurrence of PML in the context of HIV infection in South Africa.
Main Methods:
- Retrospective identification of adult patients with confirmed JC virus in cerebrospinal fluid (CSF) via real-time PCR (January 2008 - June 2012).
- Analysis of clinical manifestations, laboratory findings (including CD4 counts), and neuroimaging (CT and MRI) data.
- Review of 17 available patient records.
Main Results:
- JC virus was detected in 19 of 121 specimens; 17 patients' data were analyzed (ages 27-64).
- Common clinical symptoms included focal weakness (47%), impaired coordination (41%), and speech disturbances (12%).
- CSF analysis revealed high protein (76%) and pleocytosis (35%). Neuroimaging showed white matter lesions consistent with PML.
Conclusions:
- This is the first case series of PML from a South African neurology unit.
- The findings emphasize that PML is a common occurrence in South African patients with HIV infection.
- PML should be considered in the differential diagnosis of neurological disorders in HIV-positive individuals in this region.
