The relation of the treponematoses to idiopathic neuropathies in Jamaica

ABSTRACT

An approach is made to the aetiology of an idiopathic paraplegic syndrome in Jamaica. The main features comprise upper motor neurone paresis and sensory loss of posterior column type, with optic atrophy, nerve deafness and selective peripheral nerve lesions in a minority. Symptoms arise most commonly in the fourth decade, and show little change after the first few months. Serology is negative in the CSF in all cases and in the blood of the majority. Nevertheless some evidence of past treponemal infection can be found in over 50 percent. Abnormality of the CSF, including a positive colloidal gold reaction, is found in one third of cases; and special study of this group shows that treponemal infection has occurred in 80 percent and also that the history of illness is significantly shorter than in the remainder. Comparison of the two groups suggests that they may be progressive stages of the same syndrome. Autopsy studies reveal meningovascular and degenerative processes which are not typical of syphilis. Analysis of the geography of the condition reveals a concentration in certain inland rural areas - less than 20 percent occurring in inhabitants of Kingston. The detailed distribution closely follows that of yaws 20 years ago. The evidence is discussed that this syndrome - and perhaps some cases of frank spinal arachnoiditis - may be late manifestations of treponemal infection, whether veneral or otherwise, due to a strain variant acting as a poor stimulus to standard tests, but producing atypical meningovascular disease (Summary)