An Uncommon Etiology of Progressive Multifocal Leuckoencephalopathy Poses Diagnostic Challenges in Sub-Saharan Africa: A Study of Six Case Series
Year: 2024
Type: article
Study design: Case Report
Abstract: Objective Enhance diagnostic understanding and recognition of PML in Sub-Saharan Africa amidst prevalent immunosuppressive conditions and overlapping CNS symptoms. Background The prevalence of PML in Africa compared to Europe and America raises concerns, with 55% JC Virus seropositivity in the latter regions contrasting with unknown JC Virus sero-epidemiology in Africa. In Sub-Saharan Africa, where AIDS prevalence is high, diagnosing PML is challenging due to its rarity and symptom overlap with other CNS infections. Design/Methods Six PML cases (4 males, 2 females), aged 36-59, were observed at a tertiary neurology department from January 2015 to December 2022. Diagnosis relied on neuropathological evidence of demyelination and J.C. virus presence in the CSF. Investigations included CT, MRI, EEG, serology, CSF PCR and brain biopsy. Treatment varied depending on the underlying etiology. Results This Study demonstrates that Progressive Multifocal Leukoencephalopathy (PML) is an unrecognized condition in sub-Saharan Africa, with a male to female ratio 4:2. Clinically, cognitive impairments, motor deficits, neurosensory symptoms, and cerebellar impairment predominated. Underlying pathologies leading to severe immunosuppression included HIV (3 cases), leprosy (1 case), systemic lupus erythematosus (1 case), and African trypanosomiasis (1 case). CSF PCR testing for J.C. virus was positive in all patients. Magnetic resonance imaging aided au diagnosis revealing large and multiple areas of hypointense signal in T1 and hyperintense signal in T2 and Flair in the white matter for all patients. except the lupus case. EEG findings indicated nonspecific bioelectrical disturbances characterized by generalized slowing down, with two patients (Patients 1 and 5) showing epileptic seizures, characterized by delta and theta rhythms with abnormal peak waveforms indicative of paroxysmal epileptic activity. Conclusions Exploring PML amidst the resurgence of tropical diseases in Sub-Saharan Africa is crucial, despite diagnostic challenges due to overlapping CNS infection symptoms. Our study conducts comprehensive examinations and investigations essential for accurate diagnosis and proper treatment.
Source: Neurology
Authors: Mamadou Diallo, Souleymane Mbara Diallo, Mariama Diallo, Ibrahima Sory Barry, Ramit Singla, Amara Cisse
Institution: Medical Research Council
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206440