Neuropathies in Jamaica: a clinical and laboratory study of the aetiology of certain neurological syndromes in Jamaica with particular reference to the role of syphilis in the Jamaican Neuropathies

ABSTRACT

The characteristics of the neuropathic syndrome seen in Jamaican patients are described, and the relevant literature is reviewed in Section I. This syndrome differs from that seen in prisoners of war in that there is no clinical evidence of vitamin deficiency and spastic syndromes predominate. It differs from similar syndromes described in West Africa because of the high rate of positive tests for treponemal infection and the high incidence of spasticity. The evidence in favour of the various possible aetiological factors is examined critically and it is concluded that malnutrition, syphilis, yaws, viral and bacterial infections, bush teas, arsenical sprays and malaria are all possible causative agents. An attempt was therefore made to assess the relative importance of each. Of the patients examined, 125 fulfilled the criteria for the neuropathic syndrome. These patients were examined at least twice by me and particular attention was paid to features bearing a causal relationship to the aetiological factors mentioned above. The system of examination, the laboratory methods used, and the manner of presentation of results are described in Section II. The results are presented in Section III, and their significance is discussed in Section IV. Little evidence was found to indicate that malnutrition, toxins, and bacterial or parasitic infections were important factors in the aetiology. However, a considerable amount of evidence, direct and indirect, was accumulated to suggest that syphilis is the predominant aetiological factor in the neuropathic syndrome in Jamaican patients. Conclusions concerning the aetiology, course and treatment of this syndrome are summarised in Section V (AU)