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Neurological morbidity amongst HTLV-1 infected individuals in a rural West African population
  1. Sarah Anne Cooper (sarah.cooper{at}doctors.org.uk)
  1. Institute of Neurological Sciences, Southern General Hospital, Glasgow, United Kingdom
    1. Maarten Schim van der Loeff (mschim{at}ggd.amsterdam.nl)
    1. GGD Amsterdam, Netherlands
      1. Samuel McConkey (smcconkey{at}rcsi.ie)
      1. Department of International Health and Tropical Medicine, Royal College of Surgeons of Ireland, Republic of Ireland
        1. Maxwell Cooper (mjfcooper{at}gmail.com)
        1. Department of General Practice, University of Glasgow, United Kingdom
          1. Ramu Sarge-Njie (rnjie{at}mrc.gm)
          1. MRC Research Laboratories, Fajara, The Gambia, Gambia
            1. Steve Kaye (steve.kaye{at}imperial.ac.uk)
            1. Imperial College, United Kingdom
              1. Hilton Whittle (hwhittle{at}mrc.gm)
              1. MRC Research Laboratories, Fajara, The Gambia, Gambia

                Abstract

                Background: Community-based neurological data about HTLV-1 morbidity in sub-Saharan Africa is scarce.

                Objectives: To ascertain the prevalence of neurological morbidity, in particular Tropical Spastic Paraparesis (TSP), amongst HTLV-1-infected subjects and to compare TSP prevalence in HTLV-1-infected to that in non-infected subjects in a rural West African population.

                Methods: A cross-sectional study of HTLV-1-infected cases and controls (ratio 4:1) from a rural community (population approximately 10,000, HTLV-1 prevalence 7.7%). One neurologist masked to HTLV-1 serological status assessed all subjects. Clinical criteria were employed to diagnose TSP.

                Results: From 205 eligible cases and controls, 139 were recruited with a mean age of 56 years, 113 (81%) were HTLV-1-infected. 108/139 (78%) were female and 8/113 HTLV-1 infected cases (7.1%) had a definite or probable TSP (all females; mean age 67 years) compared with 0/26 controls. Two with TSP were co-infected with HIV-2. Complaints of back pain and leg weakness were more common in HTLV-1-infected individuals (p=0.03, p=0.02) but no single symptom distinguished between subjects with and without TSP.

                Conclusion: We report a prevalence of TSP amongst HTLV-1-infected persons in this rural West African setting of 7.1%. There are difficulties excluding other potential aetiologies here.

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