Progressive Multifocal Leukoencephalopathy With J.C in a Tropical Environment: Study of Six (6) Observations at the University Hospital of Conakry.

Abstract

Abstract Background: Progressive multifocal leukoencephalopathy (PML), related to oligodendrocyte infection by reactivation of latent John Cunningham virus (J.C.) involvement of the nervous system in the context of immunosuppression, is poorly described in sub-Saharan Africa (SSA) despite the high prevalence of AIDS, tuberculosis, leukemia, and probably autoimmune diseases. Methods: We conducted a retrospective, descriptive and analytical study of six (6) observations of progressive multifocal leukoencephalopathy in the Neurology Department of the University Hospital of Conakry. The diagnostic confirmation formerly made from the brain biopsy, was certified by PCR (J.C) in the cerebrospinal fluid, the magnetic resonance imaging in a neurological context: motor disorders, dysarthria, cognitive, cerebellar and sensory disorders. Results: This study shows that it is an unrecognized disease in sub-Saharan Africa. Men were more represented (4 men and 2 women). The clinical picture was dominated by cognitive disorders, motor deficits, neurosensory manifestations and cerebellar damage. The incriminated pathologies that led to severe immunosuppression were HIV in 3 cases, leprosy in one case, systemic lupus erythematosus in one case and African trypanosomiasis in one case. CSF PCR for J.C virus was positive in all patients. Magnetic resonance imaging contributed to the diagnosis by showing T2 hypersignals in the white matter. Conclusion: PML occurring in chronic autoimmune conditions should be sought in re-emerging tropical diseases in sub-Saharan Africa. These data are useful for the diagnostic, therapeutic and prognostic discussion.