{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T22:40:12Z","timestamp":1722465612794},"reference-count":26,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,5]]},"abstract":"<jats:p>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\u201383 years) and the median time between onset and presentation was 18 days (range, 0\u2013121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (<jats:italic>n<\/jats:italic> = 24, 41%), tumors (<jats:italic>n<\/jats:italic> = 16, 28%), and transverse myelitis (<jats:italic>n<\/jats:italic> = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with <jats:italic>Schistosoma<\/jats:italic>, <jats:italic>Treponema pallidum<\/jats:italic>, 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.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0209","type":"journal-article","created":{"date-parts":[[2019,12,14]],"date-time":"2019-12-14T07:00:55Z","timestamp":1576306855000},"page":"451-457","source":"Crossref","is-referenced-by-count":1,"title":["Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence"],"prefix":"10.4269","volume":"102","author":[{"given":"Eduard E.","family":"Zijlstra","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Medicine, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaap J.","family":"van Hellemond","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur D.","family":"Moes","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christa","family":"de Boer","sequence":"additional","affiliation":[{"name":"Infectious Disease Control, Municipal Health Service Zuid-Holland Zuid, Dordrecht, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelley A.","family":"Boeschoten","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center - Sophia Children\u2019s Hospital, Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catharina E. M.","family":"van Blijswijk","sequence":"additional","affiliation":[{"name":"Vrije Universiteit Medisch Centrum (VUMC), Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roos M.","family":"van der Vuurst de Vries","sequence":"additional","affiliation":[{"name":"Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A. B.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Gold Coast University Hospital, Southport, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Kampondeni","sequence":"additional","affiliation":[{"name":"Sam Kampondeni Clinic, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisette","family":"van Lieshout","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saskia L.","family":"Smits","sequence":"additional","affiliation":[{"name":"Viroclinics Biosciences BV, Rotterdam Science Tower, Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juri","family":"Katchanov","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, Blantyre, Malawi;"},{"name":"Department of Hematology and Oncology, LMU University of Munich, Munich, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nyengo M.","family":"Mkandawire","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Rothe","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, Blantyre, Malawi;"},{"name":"Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Spinal Cord","first-page":"1148","article-title":"Etiology of spinal cord injuries in sub-Saharan Africa","volume":"49","author":"Draulans","year":"2011"},{"key":"b2","series-title":"AJNR Am J Neuroradiol","first-page":"1634","article-title":"Acute myelopathy or cauda equina syndrome in HIV-positive adults in a tuberculosis endemic setting: MRI, clinical, and pathologic findings","volume":"35","author":"Candy","year":"2014"},{"key":"b3","series-title":"QJM","first-page":"697","article-title":"Non-traumatic myelopathy at the Chris Hani Baragwanath Hospital, South Africa\u2013the influence of HIV","volume":"104","author":"Modi","year":"2011"},{"key":"b4","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"565","article-title":"Schistosomiasis in U.S. Peace Corps Volunteers\u2013Malawi, 1992","volume":"42","author":"CDC","year":"1993"},{"key":"b5","series-title":"Brain Pathol","first-page":"649","article-title":"Neuroschistosomiasis","volume":"7","author":"Pittella","year":"1997"},{"key":"b6","series-title":"Lancet Neurol","first-page":"853","article-title":"Neuroschistosomiasis: clinical symptoms and pathogenesis","volume":"10","author":"Ferrari","year":"2011"},{"key":"b7","series-title":"Brain","first-page":"709","article-title":"Spinal cord schistosomiasis. 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