Etiological Spectrum of Non-Compressive Myelopathies in Uganda
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healthcareRecord type:
paper
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AbdKriEoiPra
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Background: Non-compressive myelopathy can lead to severe disability and death. The diagnosis is often complex and resource-intensive, with regional variation in causes. Data on the epidemiology and etiology of non-compressive myelopathy in Africa remains limited.
Methods: Using consecutive sampling, we performed a cross-sectional analysis within an established cohort of adult patients hospitalized in medical wards, all of whom exhibited clinical signs and symptoms consistent with non-compressive myelopathy at two tertiary hospitals in Kampala, Uganda. Consent was obtained from admitted patients over the age of eighteen who presented with clinical signs and symptoms of non-compressive myelopathy. Participants underwent spine magnetic resonance imaging (MRI) to rule out extradural spinal cord lesions. Serum and cerebrospinal fluid (CSF) aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing and CSF metagenomic next-generation sequencing (mNGS) were performed. Tissue biopsies and serum vitamin B12 levels were carried out at the discretion of the clinician. Descriptive statistics were used to summarize the diagnostic results and participant characteristics.
Findings: Among 420 participants screened, 144 were enrolled and included in this analysis. Seventy-nine (55%) were male, the median age was 33 years (IQR 25-44), and 38 (26%) were people living with HIV. Intradural abnormalities were identified on spinal MRI in 79 (55%) participants. An etiologic diagnosis was established in 45 (32%) participants, including neuromyelitis optica spectrum disorder (NMOSD, n=10), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD, n=7), Schistosoma mansoni (n=8), cytomegalovirus (n=1), varicella zoster virus (n=1), vitamin B12 myelopathy (n=8), infiltrating spinal cord tumor (n=8), and arteriovenous malformation (n=2).
Interpretation: This study identified a wide range of etiologies for non-compressive myelopathy in Uganda, including autoimmune myelopathies (NMOSD and MOGAD) and infectious myelopathies. These findings highlight the importance of expanding access to both autoimmune and infectious diagnostic testing in Africa.
Methods: Using consecutive sampling, we performed a cross-sectional analysis within an established cohort of adult patients hospitalized in medical wards, all of whom exhibited clinical signs and symptoms consistent with non-compressive myelopathy at two tertiary hospitals in Kampala, Uganda. Consent was obtained from admitted patients over the age of eighteen who presented with clinical signs and symptoms of non-compressive myelopathy. Participants underwent spine magnetic resonance imaging (MRI) to rule out extradural spinal cord lesions. Serum and cerebrospinal fluid (CSF) aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing and CSF metagenomic next-generation sequencing (mNGS) were performed. Tissue biopsies and serum vitamin B12 levels were carried out at the discretion of the clinician. Descriptive statistics were used to summarize the diagnostic results and participant characteristics.
Findings: Among 420 participants screened, 144 were enrolled and included in this analysis. Seventy-nine (55%) were male, the median age was 33 years (IQR 25-44), and 38 (26%) were people living with HIV. Intradural abnormalities were identified on spinal MRI in 79 (55%) participants. An etiologic diagnosis was established in 45 (32%) participants, including neuromyelitis optica spectrum disorder (NMOSD, n=10), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD, n=7), Schistosoma mansoni (n=8), cytomegalovirus (n=1), varicella zoster virus (n=1), vitamin B12 myelopathy (n=8), infiltrating spinal cord tumor (n=8), and arteriovenous malformation (n=2).
Interpretation: This study identified a wide range of etiologies for non-compressive myelopathy in Uganda, including autoimmune myelopathies (NMOSD and MOGAD) and infectious myelopathies. These findings highlight the importance of expanding access to both autoimmune and infectious diagnostic testing in Africa.
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