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Schmidt FR, Coutinho ES, Lima MA, Silva MT, Leite AC, Fonseca IO, Araujo AQ. Performance of the National Institute of Infectious Diseases disability scale in HTLV-1-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2023; 29:555-563. [PMID: 37400732 DOI: 10.1007/s13365-023-01154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic disabling disease. However, there is a lack of an adequate and specific health measurement instrument validated and with good performance to assess their degree of physical disability. This led us to carry out this study and to evaluate the performance of Fiocruz's National Institute of Infectious Diseases (IDS) disability scale, a specific instrument for HAM/TSP. Ninety-two HAM/TSP patients participated in the study. One researcher applied the IDS, IPEC scale, Disability Status Scale (DSS), Expanded DSS (EDSS), Osame scale, Beck Depression Inventory, and the WHOQOL-BREF questionnaire. In parallel, blindly, and separately, other researchers applied the IDS. An inter-rater reliability analysis of the IDS, correlation analysis with the other scales, and depression and quality of life questionnaires were performed. The applicability of the IDS was also evaluated. The IDS showed high reliability in all scores. The inter-rater reliability test for the total IDS score was 0.94 (0.82-0.98) on its four dimensions. The scale adequately indicated the different degrees of disability, presenting a distribution similar to normal. There was a high correlation with the other scales (Spearman coefficients > 0.80, p < 0.001). The scale had good acceptance among users and a short application time. IDS for HAM/TSP was reliable, consistent, easy, and fast to use. It can be used for both prospective evaluations and clinical trials. The present study supports the IDS as a valid instrument to measure disability in patients with HAM/TSP compared to previously used scales.
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Affiliation(s)
- Felipe R Schmidt
- Department of Neurology, Pedro Ernesto University Hospital, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evandro Sf Coutinho
- Department of Epidemiology, Institute of Social Medicine Hésio Cordeiro, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco A Lima
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Marcus Tt Silva
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Ana Ccb Leite
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Igor O Fonseca
- Department of Neurology and Psychiatry, Paulista State University (UNESP), Botucatu, SP, Brazil
| | - Abelardo Qc Araujo
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil.
- Postgraduate Program in Neurology and Neurosciences, Fluminense Federal University (UFF), Niteroi, RJ, Brazil.
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Kamrani M, Rad NN, Zemorshidi F, Khadem-Rezaiyan M. Prevalence of sexual dysfunction in HTLV-1 patients without spastic paraparesis and the association with psychiatric symptoms. Indian J Psychiatry 2023; 65:565-571. [PMID: 37397840 PMCID: PMC10309255 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_388_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/31/2023] [Accepted: 04/09/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The findings of previous studies are inconclusive in terms of psychological abnormalities and sexual function in asymptomatic human lymphotropic virus type 1 (HTLV-1) carriers. Aim This study aimed to evaluate the prevalence of sexual dysfunction and its relationship with psychological abnormalities in asymptomatic HTLV-1 carriers. Materials and Methods This cross-sectional study was conducted on asymptomatic HTLV-1 patients who were referred to the Neurology Clinic of a tertiary hospital in Mashhad, Iran. Patients with spastic paraparesis, leukemia, and uveitis, and those with an expanded disability status scale (EDSS) score higher than 2 were excluded. Sexual function in male and female subjects was evaluated using the brief male sexual function inventory (BMSFI) and female sexual dysfunction index (FSFI) questionnaires, respectively. The severity of psychological symptoms was evaluated in all patients using the symptom checklist-90-revised (SCL-90-R) questionnaire. Results A total of 117 patients (61 males and 56 females) with a mean age of 35.3 ± 6.3 years were evaluated. Overall, 50.9% of males had a high and 39.3% of females had a good sexual function. Both male and female patients with poor sexual function were older and had more children compared to those with good sexual function (P < 0.05). There was no significant difference in the distribution pattern of SCL-90 domains between patients with high and low to moderate sexual function among male patients (P > 0.05). Depression, hostility, interpersonal sensitivity, paranoid ideation, and psychological abnormality were significantly more prevalent in female patients with poor sexual function compared to those with good sexual function (P < 0.05). Conclusion The prevalence of psychological abnormalities was high in female with sexual dysfunction and these disorders might have a negative effect on various dimensions of sexual function.
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Affiliation(s)
- Maedeh Kamrani
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Niazi Rad
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Oliveira TSS, Andrade RCPD, Santos DND, Orrico KF, Abraão Neto J, Oliveira CJVD, Rocha PN, Carvalho EMD. Prevalence of Bowel Symptoms in Patients Infected with Human T-Lymphotropic type 1 Virus. Rev Soc Bras Med Trop 2019; 52:e20180486. [PMID: 31778419 DOI: 10.1590/0037-8682-0486-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Bowel dysfunction is frequent in patients with spinal cord diseases, but little is known about the prevalence of bowel symptoms in human T-lymphotropic virus-(HTLV-1) infected individuals. The purpose of this study is to determine the frequency of bowel symptoms in HTLV-1 infected individuals and their correlation with the degree of neurologic disease. METHODS This is a cross-sectional study comparing the frequency of bowel symptoms in HTLV-1-infected individuals* and seronegative donors (controls). Patients answered a questionnaire, the Rome III Criteria was applied, and stool consistency was evaluated by the Bristol Stool Form Scale. The individuals were classified as HTLV-1 carriers, probable HTLV-1 myelopathy and definitive HTLV-1 associated myelopathy or tropical spastic paraparesis (definitive HAM / TSP)**. RESULTS We studied 72 HTLV-1 infected individuals and 72 controls with equal age and gender distribution. Constipation was the most frequent complaint, occurring in 38 % of HTLV-1 individuals and in 15 % of the controls. In comparison to the seronegative controls, the probability of constipation occurrence was approximately 18 times higher in definitive HAM / TSP patients. Straining, lumpy or hard stools, sensation of anorectal obstruction/blockage, fewer than 3 defecations per week, flatulence, soiling, evacuation pain, and bleeding were also more frequent in the HTLV-1 patients than in the controls. Moreover, bowel symptoms were more frequent in patients with definitive or probable HAM / TSP than in carriers. CONCLUSIONS Bowel symptoms were more frequent in HTLV-1-infected patients than in seronegative controls and the frequency of bowel symptoms correlated with the severity of neurologic disease.
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Affiliation(s)
- Tatiane Souza Soares Oliveira
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Reabilitação, Salvador, BA, Brasil.,Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil
| | - Rosana Cristina Pereira de Andrade
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Reabilitação, Salvador, BA, Brasil.,Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil
| | - Dislene Nascimento Dos Santos
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Reabilitação, Salvador, BA, Brasil
| | - Keith Froes Orrico
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil
| | - José Abraão Neto
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil
| | - Cassius José Vitor de Oliveira
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil
| | - Paulo Novis Rocha
- Universidade Federal da Bahia, Escola de Medicina, Departamento de Medicina Interna e Apoio Diagnóstico, Salvador, BA, Brasil
| | - Edgar Marcelino de Carvalho
- Universidade Federal da Bahia, Complexo Hospitalar Professor Edgard Santos, Departamento de Imunologia, Salvador, BA, Brasil.,Fundação Oswaldo Cruz-Bahia, Instituto Gonçalo Moniz, Laboratório de Pesquisas Clínicas, Salvador, BA, Brasil.,Ministério da Ciência, Tecnologia, Inovações e Comunicações, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, BA, Brasil
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Human T-Lymphotropic Virus-1-Associated Myelopathy/Tropical Spastic Paraparesis Is Associated With Sexual Dysfunction in Infected Women of Reproductive Age. Sex Med 2018; 6:324-331. [PMID: 30181035 PMCID: PMC6302128 DOI: 10.1016/j.esxm.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/14/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Human T-lymphotropic virus (HTLV)-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disorder that mostly affects women. This disease is characterized by a progressive loss of motor function and disruptions in sensory function in the lower limbs. HTLV-1 is also associated with isolated neurologic dysfunctions, overactive bladder, and erectile dysfunction. The occurrence of sexual dysfunction in HTLV-1–infected women remain unclear. Aim To investigate associations between HTLV-1 infection and sexual dysfunction in both asymptomatic infected women and those diagnosed with HAM/TSP compared with uninfected women. Methods HTLV-1–infected and uninfected women were assessed for sexual dysfunction using the Female Sexual Function Index instrument. Sexual dysfunction was considered if global Female Sexual Function Index scores were <26.5. Crude and adjusted prevalence ratios (PR) with 95% CI were calculated to identify associations between sexual dysfunction (outcome) and HTLV infection status–asymptomatic or HAM/TSP (main exposure), compared with uninfected women, and adjusted by sociodemographic and/or clinical characteristics (covariables). Results HTLV-1–infected women (n = 72; 57 asymptomatic; 15 HAM/TSP) and HTLV-1 uninfected women (n = 49) were evaluated. The overall sexual dysfunction prevalence was 53.7% (65/121), which was higher in the HAM/TSP group (80.0%; adjusted PR 1.89; 95% CI 1.23–2.90) when compared with non-infected individuals (44.9%). Sexual dysfunction was found in 54.4% of the HTLV-1–infected asymptomatic women (PR 1.21; 95% CI 0.82–1.79). Sexual dysfunction was associated with income lower than 1 minimal wage (∼US $300, October 2017) and number of previous birthday. Conclusion The obtained results indicate that sexual dysfunction is associated with HAM/TSP in women infected with HTLV-1 of reproductive age. Lima Lopes Martins A, Rios Grassi MF, de Aquino Firmino A, et al. Human T-Lymphotropic Virus-1–Associated Myelopathy/Tropical Spastic Paraparesis Is Associated With Sexual Dysfunction in Infected Women of Reproductive Age. Sex Med 2018;6:324–331.
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Lima LM, Cardoso LS, Santos SB, Oliveira RR, Oliveira SC, Góes AM, Loukas A, Araujo MI. Schistosoma antigens downregulate CXCL9 production by PBMC of HTLV-1-infected individuals. Acta Trop 2017; 167:157-162. [PMID: 28040482 DOI: 10.1016/j.actatropica.2016.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 12/08/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
Abstract
HTLV-1 is the causal agent of Adult T cell Leukemia/lymphoma (ATLL) and HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP). The immune response to HTLV-1-infection is polarized to the Th1-type, and the presence of CXCL9/CXCL10 chemokines may lead to an increase in the recruitment of pro-inflammatory molecules in spinal cord tissue, contributing to the damage observed in the development of HAM/TSP. It has been observed that in chronic helminth-infections, such as schistosomiasis, there is a deviation toward the Th2/regulatory immune response. OBJECTIVE To evaluate the ability of Schistosoma spp. proteins to decrease the in vitro CXCL9 and CXCL10 production by PBMC of HTLV-1-infected individuals. METHODS The Schistosoma proteins rSm29, rSh-TSP-2 and PIII were added to PBMC cultures of HTLV-1-infected individuals and the levels of chemokines in the supernatants were measured using a sandwich ELISA method. RESULTS The addition of rSm29 to the cultures resulted in decreased production of CXCL9 in all the analyzed individuals and HAM/TSP group (18167±9727pg/mL, p=0.044; 20237±6023pg/mL, p=0.028, respectively) compared to the levels in unstimulated cultures (19745±9729pg/mL; 25078±2392pg/mL, respectively). The addition of rSh-TSP-2 decreased the production of CXCL9 in all studied individuals and carriers group (16136±9233pg/mL, p=0.031; 13977±8857pg/mL, p=0.026) vs unstimulated cultures (19745±9729pg/mL; 18121±10508pg/mL, respectively). Addition of PIII did not alter the results. There was no significant change in the levels of CXCL10 by the addition of the studied proteins. CONCLUSION The Schistosoma proteins used in this study were able to down modulate the production of CXCL9, a chemokine associated with the inflammatory process in HTLV-1-infection.
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Espíndola OM, Vizzoni AG, Lampe E, Andrada-Serpa MJ, Araújo AQC, Leite ACC. Hepatitis C virus and human T-cell lymphotropic virus type 1 co-infection: impact on liver disease, virological markers, and neurological outcomes. Int J Infect Dis 2017; 57:116-122. [PMID: 28185943 DOI: 10.1016/j.ijid.2017.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Human T-cell lymphotropic virus type 1 (HTLV-1) infection is associated with neurological abnormalities, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and peripheral neuropathy (PN). Hepatitis C virus (HCV) infection is the leading cause of chronic liver disease worldwide, and causes PN in approximately 9% of patients. Because the interplay between these potentially neuropathogenic viruses in the same individual is still poorly understood, the clinical and laboratory outcomes of co-infected patients were evaluated and compared with those of controls. METHODS The prevalence rates of neurological and laboratory abnormalities were evaluated in HCV/HTLV-1 co-infected patients (n=50), and in subjects with single HCV (n=46) or HTLV-1 (n=150) infection. RESULTS A higher frequency of isolated PN was present in HCV-infected patients; this was not associated with cryoglobulinemia. No difference was found in the frequency of PN or HAM/TSP when co-infected subjects were compared to singly infected subjects. Hepatic involvement was present in HCV-infected subjects, as shown by increased levels of serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and bilirubin, in addition to thrombocytopenia. On the other hand, HCV/HTLV-1 co-infected individuals presented a better prognosis for hepatic involvement when compared with singly HCV-infected subjects. CONCLUSIONS These data suggest that HCV/HTLV-1 co-infection does not mutualistically alter the outcome with regard to neurological manifestations. Nonetheless, changes in the immunological environment induced by HTLV-1 infection could lead to a reduction in hepatic damage, even without significant HCV clearance.
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Affiliation(s)
- Otávio M Espíndola
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Alexandre G Vizzoni
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Elisabeth Lampe
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute (IOC) - FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria José Andrada-Serpa
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Abelardo Q C Araújo
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Ana Claudia C Leite
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute for Infectious Diseases (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil.
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Orge GO, Dellavechia TR, Carneiro-Neto JA, Araújo-de-Freitas L, Daltro CHC, Santos CT, Quarantini LC. Psychiatric Disorders in HTLV-1-Infected Individuals with Bladder Symptoms. PLoS One 2015; 10:e0128103. [PMID: 26018525 PMCID: PMC4446325 DOI: 10.1371/journal.pone.0128103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies have reported high rates of depression and anxiety in HTLV-1 infected individuals with the neurological disease and in the asymptomatic phase. No study has investigated the rates in individuals that already show bladder symptoms without severe neurological changes; that is, during the oligosymptomatic phase. The present study investigated patients in this intermediate form on the spectrum of the infection. METHODOLOGY/PRINCIPAL FINDINGS Participants answered a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (MINI PLUS) and the Hospital Anxiety and Depression Scale (HADS). Data analysis was performed in STATA statistical software (version 12.0). Depressive disorder was the most frequent comorbidity. Current depressive disorder was higher in the group of overactive bladder subjects (11.9%), and lifelong depression was more frequent in the HAM/TSP group (35%). The three groups had similar frequencies of anxiety disorders. Increased frequency and severity of anxiety and depression symptoms were observed in the overactive bladder group. CONCLUSION/SIGNIFICANCE The results suggest that individuals with overactive bladders need a more thorough assessment from the mental health perspective. These patients remain an understudied group regarding psychiatric comorbidities.
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Affiliation(s)
- Glória O Orge
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Thais R Dellavechia
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | | | - Lucas Araújo-de-Freitas
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Carla H C Daltro
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil; Escola de Nutrição, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Carlos T Santos
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Lucas C Quarantini
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil; Departamento de Neurociências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
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Tanajura D, Castro N, Oliveira P, Neto A, Muniz A, Carvalho NB, Orge G, Santos S, Glesby MJ, Carvalho EM. Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: A Longitudinal Cohort Study. Clin Infect Dis 2015; 61:49-56. [PMID: 25820277 DOI: 10.1093/cid/civ229] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/01/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human T-cell lymphotropic virus type 1 (HTLV-1) is the agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), observed in up to 5% of infected individuals. Despite low prevalence, many HTLV-1-infected patients who do not fulfill criteria for HAM/TSP present with neurological complaints related to sensory, motor, urinary, or autonomic manifestations. The aim of this study was to determine the incidence of neurologic manifestations and risk factors associated with these outcomes. METHODS The incidence of HAM/TSP and new signs and neurologic symptoms were computed in a group of patients enrolled in a cohort study. RESULTS Of 414 subjects, 76 had definite HAM/TSP, 87 had possible or probable HAM/TSP, and 251 subjects had no neurologic manifestation and were selected for analysis. Definite HAM/TSP developed in 5 (1.47%) patients. Follow-up of at least 3 years was achieved in 51% of patients. The incidence rate was computed in 1000 person-years (206 for hand numbness, 187 for feet numbness, 130 for nocturia, and 127 for urgency). Average incidence rate in neurological exam was 76 for leg hyperreflexia, 53 for leg weakness, and 37 for Babinski sign. In the applied Expanded Disability Status Scale, the incidence rate of worsening 1 point was 134 per 1000 person-years. Kaplan-Meier curves stratified by sex and proviral load showed that females and patients with proviral load >50,000 copies/10(6) peripheral blood mononuclear cells had a higher risk of progression. CONCLUSIONS Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up.
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Affiliation(s)
- Davi Tanajura
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Department of Natural Sciences, State University of Bahia Southeast, Vitória da Conquista
| | - Néviton Castro
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Paulo Oliveira
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Abraão Neto
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - André Muniz
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Natália B Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Glória Orge
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Silvane Santos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Department of Biological Sciences, State University of Feira de Santana, Bahia, Brazil
| | - Marshall J Glesby
- Department of Medicine, Weill Cornell Medical College, New York, New York; and
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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Functional activity of monocytes and macrophages in HTLV-1 infected subjects. PLoS Negl Trop Dis 2014; 8:e3399. [PMID: 25521499 PMCID: PMC4270688 DOI: 10.1371/journal.pntd.0003399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/07/2014] [Indexed: 12/13/2022] Open
Abstract
The Human T lymphotropic virus type-1 (HTLV-1) infects predominantly T cells, inducing proliferation and lymphocyte activation. Additionally, HTLV-1 infected subjects are more susceptible to other infections caused by other intracellular agents. Monocytes/macrophages are important cells in the defense against intracellular pathogens. Our aims were to determine the frequency of monocytes subsets, expression of co-stimulatory molecules in these cells and to evaluate microbicidal ability and cytokine and chemokine production by macrophages from HTLV-1 infected subjects. Participants were 23 HTLV-1 carriers (HC), 22 HAM/TSP patients and 22 healthy subjects (HS) not infected with HTLV-1. The frequencies of monocyte subsets and expression of co-stimulatory molecules were determined by flow cytometry. Macrophages were infected with L. braziliensis or stimulated with LPS. Microbicidal activity of macrophages was determined by optic microscopy. Cytokines/chemokines from macrophage supernatants were measured by ELISA. HAM/TSP patients showed an increase frequency of intermediate monocytes, but expression of co-stimulatory molecules was similar between the groups. Macrophages from HTLV-1 infected individuals were infected with L. braziliensis at the same ratio than macrophages from HS, and all the groups had the same ability to kill Leishmania parasites. However, macrophages from HTLV-1 infected subjects produced more CXCL9 and CCL5, and less IL-10 than cells from HS. While there was no correlation between IFN-γ and cytokine/chemokine production by macrophages, there was a correlation between proviral load and TNF and CXCL10. These data showed a dissociation between the inflammatory response and microbicidal ability of macrophages from HTLV-1 infected subjects. While macrophages ability to kill an intracellular pathogen did not differ among HTLV-1 infected subjects, these cells secreted high amount of chemokines even in unstimulated cultures. Moreover the increasing inflammatory activity of macrophages was similar in HAM/TSP patients and HC and it was related to HTLV-1 proviral load rather than the high IFN-γ production observed in these subjects.
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Souza A, Tanajura D, Toledo-Cornell C, Santos S, Carvalho EMD. Immunopathogenesis and neurological manifestations associated to HTLV-1 infection. Rev Soc Bras Med Trop 2013; 45:545-52. [PMID: 23152334 DOI: 10.1590/s0037-86822012000500002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/14/2012] [Indexed: 12/14/2022] Open
Abstract
The human T lymphotropic virus type-1 (HTLV-1) was the first human retrovirus identified. The virus is transmitted through sexual intercourse, blood transfusion, sharing of contaminated needles or syringes and from mother to child, mainly through breastfeeding. In addition to the well-known association between HTLV-1 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), several diseases and neurologic manifestations have been associated with the virus. This review was conducted through a PubMed search of the terms HTLV-1, immune response and neurological diseases. Emphasis was given to the most recent data regarding pathogenesis and clinical manifestations of HTLV-1 infection. The aim of the review is to analyze the immune response and the variety of neurological manifestations associated to HTLV-1 infection. A total of 102 articles were reviewed. The literature shows that a large percentage of HTLV-1 infected individuals have others neurological symptoms than HAM/TSP. Increased understanding of these numerous others clinical manifestations associated to the virus than adult T cell leukemia/lymphoma (ATLL) and HAM/TSP has challenged the view that HTLV-1 is a low morbidity infection.
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Affiliation(s)
- Anselmo Souza
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
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Immunologic response and proviral load in human T-lymphotropic virus type 1 infected individuals with erectile dysfunction. Urology 2013; 81:1261-4. [PMID: 23726450 DOI: 10.1016/j.urology.2013.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/01/2013] [Accepted: 02/11/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the immune response and proviral load in individuals with human T-lymphotropic virus type 1 (HTLV-1) and erectile dysfunction (ED) compared with those in the controls. MATERIALS AND METHODS We performed a cross-sectional study of 102 men aged 18-70 years with positive serology for HTLV-1, who were interviewed from 2004 to 2010. The study sample was divided into 2 groups: group 1, 42 HTLV-1-infected men with ED, as determined by the International Index of Erectile Function-5 score; and group 2, 60 HTLV-1-infected men without ED. The cytokines interferon-γ and tumor necrosis factor-α, and the proviral load were analyzed between the 2 groups. RESULTS Compared with those without ED, the men with ED had greater levels of tumor necrosis factor-α (545.37 ± 877.06 vs 509.39 ± 724.70 pg/mL) and interferon-γ (1154.35 ± 1282.98 vs 1122.78 ± 1573.16 pg/mL), but this difference was not significant (P = .69 and P = .57, respectively). The proviral load was 135,695 ± 190,113 copies/10(5) cells in the ED group and 47,607 ± 83,129 copies/10(5) cells in the non-ED patients, with a statistically significant difference (P = .02). When ED was stratified as mild, moderate, and severe, no difference was found in the proviral load among the ED groups (P = .09); however, the levels were greater in the severe forms. CONCLUSION The association of a greater proviral load in men with ED with HTLV-1 gives support to the idea that ED is part of the autonomic syndrome related to viral infection and should be investigated for early identification of the syndrome.
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Lima LM, Santos SB, Oliveira RR, Cardoso LS, Oliveira SC, Góes AM, Loukas A, Carvalho EM, Araújo MI. Schistosoma antigens downmodulate the in vitro inflammatory response in individuals infected with human T cell lymphotropic virus type 1. Neuroimmunomodulation 2013; 20:233-8. [PMID: 23752304 DOI: 10.1159/000348700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Human T cell lymphotropic virus type 1 (HTLV-1) is the causal agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). While the immune response to HTLV-1 infection is polarized to the Th1-type, chronic helminth infections drive the Th2- and T regulatory-type, and are able to downregulate the inflammatory response in some autoimmune diseases. OBJECTIVE To evaluate whether Schistosoma spp. antigens alter the in vitro cytokine response in HTLV-1 infection. METHODS The recombinant Schistosoma antigens Sm29 and ShTSP2 (tetraspanin) and PIII, a fraction of the Schistosoma mansoni adult worm antigen were added to peripheral blood mononuclear cell (PBMC) cultures of HTLV-1-infected individuals and the levels of interferon (IFN)-γ and interleukin (IL)-10 in the supernatants were measured using the ELISA sandwich technique. RESULTS Compared to the levels of cytokine in nonstimulated cultures, the levels of IFN-γ were reduced in 50, 47 and 50% of patients by the presence of Sm29, ShTsp2 and PIII, respectively. The downregulation of IFN-γ production in the presence of Sm29 antigen was observed mainly in subjects who had lower basal levels of this cytokine. The levels of IL-10, however, increased by the addition of the three antigens in the cultures in 74, 62 and 44% of individuals, respectively. In addition, there was a decrease in the ratio of IFN-γ/IL-10 levels in cultures stimulated with Sm29 and ShTSP2 when compared to nonstimulated ones. CONCLUSIONS The Schistosoma spp. antigens used in this study were able to downmodulate IFN-γ production in vitro in HTLV-1 infection. This may be associated with the increased levels of IL-10 induced by the antigens.
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Affiliation(s)
- Luciane Mota Lima
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador Bahia, Brazil
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Nascimento OJ, Marques W. Human T-cell leukemia virus (HTLV)-associated neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:531-41. [DOI: 10.1016/b978-0-444-52902-2.00030-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Luna T, Santos SB, Nascimento M, Porto MAF, Muniz AL, Carvalho EM, Jesus AR. Effect of TNF-α production inhibitors on the production of pro-inflammatory cytokines by peripheral blood mononuclear cells from HTLV-1-infected individuals. Braz J Med Biol Res 2011; 44:1134-40. [PMID: 22011961 DOI: 10.1590/s0100-879x2011007500140] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 09/29/2011] [Indexed: 01/06/2023] Open
Abstract
Human T lymphotropic virus type 1 (HTLV-1) is the causal agent of myelopathy/tropical spastic paraparesis (HAM/TSP), a disease mediated by the immune response. HTLV-1 induces a spontaneous proliferation and production of pro-inflammatory cytokines by T cells, and increasing interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) levels are potentially involved in tissue damage in diseases related to HTLV-1. This exaggerated immune response is also due to an inability of the natural regulatory mechanisms to down-modulate the immune response in this group of patients. TNF-α inhibitors reduce inflammation and have been shown to improve chronic inflammatory diseases in clinical trials. The aim of this study was to evaluate the ability of pentoxifylline, forskolin, rolipram, and thalidomide to decrease in vitro production of TNF-α and IFN-γ in cells of HTLV-1-infected subjects. Participants of the study included 19 patients with HAM/TSP (mean age, 53 ± 11; male:female ratio, 1:1) and 18 HTLV-1 carriers (mean age, 47 ± 11; male:female ratio, 1:2.6). Cytokines were determined by ELISA in supernatants of mononuclear cell cultures. Pentoxifylline inhibited TNF-α and IFN-γ synthesis with the minimum dose used (50 µM). The results with forskolin were similar to those observed with pentoxifylline. The doses of rolipram used were 0.01-1 µM and the best inhibition of TNF-α production was achieved with 1 µM and for IFN-γ production it was 0.01 µM. The minimum dose of thalidomide used (1 µM) inhibited TNF-α production but thalidomide did not inhibit IFN-γ production even when the maximum dose (50 µM) was used. All drugs had an in vitro inhibitory effect on TNF-α production and, with the exception of thalidomide, all of them also decreased IFN-γ production.
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Affiliation(s)
- T Luna
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
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Champs APS, Passos VMDA, Barreto SM, Vaz LS, Ribas JGR. [HTLV-1 associated myelopathy: clinical and epidemiological profile in a 10-year case series study]. Rev Soc Bras Med Trop 2011; 43:668-72. [PMID: 21181020 DOI: 10.1590/s0037-86822010000600013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/20/2010] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Human T cell lymphotropic virus type 1 (HTLV-I) myelopathy (HAM/TSP) is a progressive disabling disorder. This work aimed to analyze clinical features and epidemiology in a sample of HAM/TSP. METHODS All HTLV-1 infected patients with diagnostic criteria for HAM/TSP, consecutively admitted to the Sarah Hospital from 1998 to 2007, were included in the study. RESULTS 206 patients (67% females; mean age: 53.8 years-old) were diagnosed with HAM/TSP. The mean time of evolution was 9.0 years. The most common neurological symptoms were chronic progressive spastic paraparesis, spasticity, pain, neurogenic bladder and neurogenic bowel. The neurological findings were hyperreflexia, Babinsky, Hoffman and peripheral neuropathy. Pain, spasticity and spinal cord atrophy, observed in MRI, were associated with time of disease (p<0.05). CONCLUSIONS HAM/TSP is a very disabling disorder, in which pain is reported early, while spasticity and thoracic spinal cord atrophy appear in a later phase of the disease. Cases of HAM/TSP exist with a probable vertical viral transmission.
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Clinical manifestations in individuals with recent diagnosis of HTLV type I infection. J Clin Virol 2011; 51:54-8. [PMID: 21388871 DOI: 10.1016/j.jcv.2011.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 01/07/2011] [Accepted: 02/07/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human T-lymphotropic virus type 1 (HTLV-1) is known to cause HTLV-associated myelopathy (HAM)/tropical spastic paraparesis and adult T cell leukemia. A growing body of evidence links HTLV-1 infection with an increasing spectrum of disease, including uveitis, periodontal disease, arthropathy, sicca syndrome, and neurologic deficits. OBJECTIVES Despite recent findings, the natural history of HTLV-1 infection remains poorly defined. This study was designed to better characterize initial clinical and neurological findings in individuals diagnosed with HTLV-1 infection. STUDY DESIGN We conducted a cross-sectional study of 71 individuals recently diagnosed with HTLV-1 and 71 uninfected age- and sex-matched blood donors in Salvador, Brazil. Subjects were administered a standardized questionnaire and underwent physical exam. RESULTS HTLV-1 infected subjects were significantly more likely than controls to report complaints of hand and foot numbness (OR=5.3; 95% CI: 1.8-15.3; p=0.002 and OR=4.0; 95% CI: 1.3-12; p=0.013 respectively), difficulty running (OR=4.0; 95% CI: 1.1-14.2; p=0.032), nocturia (OR=5.0; 95% CI: 1.1-22.8; p=0.038), arthralgia (OR=3.3; 95% CI: 1.4-7.7; p=0.006), and photophobia (OR=3.3; 95% CI: 1.4-7.7; p=0.006). CONCLUSIONS Neurologic, ocular and rheumatologic complaints may be the first manifestations of HTLV-1 infection. Therefore, all patients presenting with initial diagnosis should be rigorously screened for these symptoms.
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Prevalence of erectile dysfunction in HTLV-1-infected patients and its association with overactive bladder. Urology 2010; 75:1100-3. [PMID: 20189229 DOI: 10.1016/j.urology.2009.11.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/13/2009] [Accepted: 11/21/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the prevalence of erectile dysfunction (ED) in human T-cell lymphotropic virus type I (HTLV-I)-infected patients, and its association with overactive bladder (OB). METHODS In a cross-sectional study, 111 male patients with positive serology for HTLV-I (by enzyme-linked immunosorbent assay and Western blot) were examined between October 2003 and December 2006. Exclusion criteria were age <18 and >80 years, other neurological diseases, penile prosthesis, neoplasm, and psychological and mental disease. Patients were evaluated by a urologist and neurologist. ED was determined by application of the abridged form of 5-item International Index of Erectile Function (IIEF-5). ED was defined as IIEF-5 <or= 21. OB was determined by International Continence Society criteria. Using the Expanded Disability Status Scale (EDSS) to determine disautonomy status, a neurologist classified all patients as either asymptomatic carriers (EDSS = 0), "oligosymptomatic myelopathy" (EDSS > 0 e <or= 2), or HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP); (EDSS > 2). Diagnosis of HAM/TSP was performed according to World Health Organization recommendations. RESULTS Of the total of 111 patients, 6 were excluded and 105 were analyzed. The mean age was 48 +/- 10.7 years. ED was observed in 55.2%. ED was documented in all patients who had HAM/TSP, in 79% of the group with EDSS > 0 and <or=2, and in 35.9% of HTLV-1-infected individuals with EDSS = 0. OB was detected in 93.75%, 33.3%, and 4.6%, respectively. Moreover, there was an association observed between ED and OB. CONCLUSIONS ED is a frequent disease in HTLV-I-infected individuals, and the prevalence is directly correlated to the degree of neurological disability measured by EDSS. ED was strongly associated with OB symptoms.
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Biswas HH, Engstrom JW, Kaidarova Z, Garratty G, Gibble JW, Newman BH, Smith JW, Ziman A, Fridey JL, Sacher RA, Murphy EL. Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy. Neurology 2009; 73:781-9. [PMID: 19738173 DOI: 10.1212/wnl.0b013e3181b6bba9] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. METHODS An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. RESULTS HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. CONCLUSIONS These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.
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Affiliation(s)
- H H Biswas
- Blood Systems Research Institute, San Francisco, CA, USA
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Morgan DJ, Caskey MF, Abbehusen C, Oliveira-Filho J, Araujo C, Porto AF, Santos SB, Orge GO, Joia MJ, Muniz AL, Siqueira I, Glesby MJ, Carvalho E. Brain magnetic resonance imaging white matter lesions are frequent in HTLV-I carriers and do not discriminate from HAM/TSP. AIDS Res Hum Retroviruses 2007; 23:1499-504. [PMID: 18160007 PMCID: PMC2593463 DOI: 10.1089/aid.2007.0077] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human T lymphotropic virus (HTLV)-I is known to cause HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and other pronounced disease in less than 4% of those infected. However, evidence is accumulating that a proportion of HTLV-I carriers have neurological and urological symptoms without fulfilling criteria for HAM/TSP. Brain white matter (WM) lesions on magnetic resonance imaging (MRI) are frequently seen in HAM/TSP. HTLV-I carriers with MRI scans for other neurological diagnoses have WM lesions more frequently than expected. We studied 10 patients with HAM/TSP and 20 HTLV-I carriers without overt neurological disease and evaluated clinical characteristics, viral load, total, small, large, confluent WM lesion number, and lesion volume on MRI. Cerebral WM lesions were found in of 85% of HTLV-I carriers and 80% of HAM/TSP patients. Lesion number, size or location was no different between carriers and HAM/TSP. Cognitive function was lower in HAM/TSP (p = 0.045) but did not correlate with WM lesion number. Viral load and peripheral blood mononuclear cell interferon production correlated positively (p = 0.001) but did not correlate with lesion number or volume. Conventional brain MRI frequently shows WM lesions in HTLV-I-infected individuals suggesting potential early central nervous system inflammation with rare development of progressive disease.
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Affiliation(s)
- Daniel J Morgan
- Department of International Medicine and Infectious Disease, Weill Medical College of Cornell University, New York, New York 10021, USA
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Castro NM, Freitas DM, Rodrigues W, Muniz A, Oliveira P, Carvalho EM. Urodynamic features of the voiding dysfunction in HTLV-1 infected individuals. Int Braz J Urol 2007; 33:238-44; discussion 244-5. [PMID: 17488545 DOI: 10.1590/s1677-55382007000200016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe urodynamic abnormalities in HTLV-1 infected individuals presenting urinary symptoms and verify if these findings and quality of life (QOL) evaluation correlate with overall neurological impairment. MATERIALS AND METHODS From January/2001 to May/2004, 324 HTLV-1 seropositive subjects were evaluated to determine the occurrence of urinary symptoms. Urodynamic testing was performed in those who complained of frequency, urgency, or incontinence. They went through a complete clinical, neurological, and urological examination to investigate symptoms and signs of myelopathy. Neurological disability was assessed by Expanded Disability Status Scale (EDSS). RESULTS From the 324 patients evaluated, 78 underwent the urodynamic testing. Fifty-seven individuals were females (73.1%) and age ranged from 23 to 76 years (mean=48.7 years; SD +/- 11.6). Urodynamic testing was abnormal in 63 patients (80.8%). The major abnormality was detrusor overactivity (DO), observed in 33 individuals (33/63; 52.4%), followed by detrusor-external sphincter dyssynergia (DESD), diagnosed in 15 subjects (15/63; 25.4%). HAM/TSP patients had significantly more DESD than the HTLV-I carriers (p=0.005; OR=5.5; CI: 1.6 to 19.4). QOL was severely compromised in HAM/TSP patients. CONCLUSIONS Prominent urodynamic abnormalities were identified in individuals genuinely considered as HTLV-I carriers, suggesting an early compromise of the urinary tract; whereas HAM/TSP patients presented urodynamic findings, which posed a potential risk to the upper urinary tract (dyssynergia). Urodynamic evaluation should be performed in all HTLV-I-infected individuals with voiding complaints.
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Affiliation(s)
- Neviton M Castro
- Section of Immunology, University Hospital, Bahia Federal University, Salvador, Bahia, Brazil.
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Oliveira P, Castro NMD, Carvalho EM. Urinary and sexual manifestations of patients infected by HTLV-I. Clinics (Sao Paulo) 2007; 62:191-6. [PMID: 17505705 DOI: 10.1590/s1807-59322007000200015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 11/20/2006] [Indexed: 11/22/2022] Open
Abstract
HTLV-I is considered to be a virus of low morbidity, since the principal diseases associated with this viral infection, HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL), are observed in less than 5% of infected individuals. Urinary symptoms are frequent in patients with myelopathy and consist principally of nocturia, frequency, urgency, and urinary incontinence; however, the importance of these dysfunctions and their correlation with myelopathy is still to be fully clarified. This review gives particular emphasis to the high frequency of urinary and sexual complaints not only in patients with myelopathy but also in individuals considered to be HTLV-I carriers. Detrusor overactivity and bladder-sphincter dyssynergia are the most common urodynamic findings. The fact that urinary complaints and urodynamic parameters reported in individuals considered to be carriers are similar to those detected in patients with myelopathy supports the hypothesis that urinary disorders may represent an oligosymptomatic form of HAM/TSP. Erectile dysfunction is frequently observed in HTLV-I-infected patients with or without myelopathy. Urinary tract infections are also highly prevalent in these patients. Despite the lack of an effective treatment for myelopathy, the use of anticholinergic drugs and phosphodiesterase type 5 (PDE5) inhibitors may improve urinary complaints and erectile dysfunction in these patients.
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Affiliation(s)
- Paulo Oliveira
- Immunology Service, Hospital Universitário, Federal University of Bahia, Salvador, BA, Brazil.
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