TROPICAL SPASTIC PARAPARESIS HTLV-I-ASSOCIATED MYELOPATHY IN EUROPE AND IN AFRICA - CLINICAL AND EPIDEMIOLOGIC ASPECTS/

We review here the epidemiologic and clinical aspects of tropical spas tic paraparesis, human T-cell lymphotropic virus type I (HTLV-I)-assoc iated myelopathy (TSP/HAM) as observed in Europe and in Africa, Europe is not an endemic region for HTLV-I (seroprevalence in blood donors, <0.03%), and TSP/HAM is thus rarely observed in European countries, Mo st of the few patients suffering from TSP/HAM are first- or second-gen eration immigrants from HTLV-I endemic areas (mostly the West Indies), and the clinicoepidemiologic aspects of these patients are similar to those seen in endemic areas. However, rare cases occur in European-bo rn subjects with or without risk factors for HTLV-I infection, which r aises the possibility of limited foci areas in Europe. Although Africa is considered as a primary HTLV-I endemic area, with al least a few m illion infected inhabitants, epidemiologic data on the situation of TS P/HAM in Africa remain scarce, Relatively few cases of patients with T SP/HAM have been reported in Africa, including some clusters in Zaire (prevalence, 50/100,000) and in South Africa and sporadically in the m ain cities of some Western, Central, and Eastern African countries. Th e paucity of clinical and epidemiologic data on TSP/HAM may be linked to several factors, including the paucity of neurologists, the lack of laboratory and radiologic facilities, and the chronicity of the disea se, along with the limited number of field epidemiologic studies perfo rmed on this topic and the wide diversity of causes (toxic, nutritiona l, and infectious) of chronic myelopathies as seen on the African cont inent.