HTLV-I infection and neurological disease in Rio de Janeiro

Advances in the treatment of human T-cell lymphotropic virus type-I associated myelopathy

INTRODUCTION

Nearly 2-3% of those 10 to 20 million individuals infected with the Human T-cell lymphotropic virus type-1 (HTLV-1); are predisposed to developing HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). It is a neuro-inflammatory disease; differentiated from multiple sclerosis based on the presence of typical neurologic symptoms, confirmation of HTLV-1 infection, and other molecular biomarkers.

AREAS COVERED

A brief review of the epidemiology, host immune responses, and molecular pathogenesis of HAM/TSP is followed by detailed discussions about the host-related risk factors for developing HAM/TSP and success/failure stories of the attempted management strategies.

EXPERT OPINION

Currently, there is no effective treatment for HAM/TSP. Anti-retroviral therapy, peculiar cytokines (IFN-α), some anti-oxidants, and allograft bone marrow transplantation have been used for treating these patients with limited success. Under current conditions, asymptomatic carriers should be examined periodically by a neurologist for early signs of spinal cord injury. Then it is crucial to determine the progress rate to adapt the best management plan for each patient. Corticosteroid therapy is most beneficial in those with acute myelitis. However, slow-progressing patients are best managed using a combination of symptomatic and physical therapy. Additionally, preventive measures should be taken to decrease further spread of HTLV-1 infection.

Pain in tropical spastic paraparesis/HTLV-I associated myelopathy patients

OBJECTIVE: Tropical Spastic Paraparesis/HTLV-I Associated Myelopathy (TSP/HAM) is a chronic myelopathy, and pain has been mentioned as a frequent sensory symptom in this condition. The authors aimed at analyzing this symptom in a TSP/HAM patients series. METHOD: For this, 46 patients were analyzed considering demographic and clinical characteristics and complaint of pain as to verbal description, time of onset and classification, correlated with the degree of motor disability and type of pain. RESULTS: Among the 46 TSP/HAM patients, 28 (60.8%) complained of pain, predominant in the early phase of the disease. Most of the patients exhibited neuropathic characteristics of pain, correlated with increased motor disability. CONCLUSION: Pain in TSP/HAM patients is a frequent and early symptom, and the neuropathic type is predominant (57.1%) and paralleled with increased incapacitation. The pathogenic involvement of cytokines may possibly be involved in the meaning of this symptom in this condition.

Human T-cell lymphotropic virus type 1 provirus and phylogenetic analysis in patients with mycosis fungoides and their family relatives

BACKGROUND

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma of unknown aetiology. A pathogenic role of human T-cell lymphotropic virus type 1 (HTLV-1) has been suggested but remains controversial. To determine whether MF is linked to HTLV-1.

METHODS

Blood samples were collected from 60 patients, 15 family relatives of patients with MF (MFRs), 20 healthy controls and 10 patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The presence of HTLV-1 antibodies in serum was tested by the Western blot rp21e-enhanced test. DNA was extracted from the blood with the Qiagen blood kit. We used 500 ng of DNA either in conventional HTLV-1-specific polymerase chain reaction (PCR) or in real-time PCR using primers sk43 and sk44 together with a tax-specific fluorescent probe.

RESULTS

In Western blot, antibodies against three to four HTLV-1 antigens were detected in 52% of patients with MF. All of the patients with HAM/TSP were positive, while only 7% of the MFRs and none of the 20 healthy controls reacted with HTLV-1 antigens in Western blot. One of 60 patients with MF and one of 15 MFRs were positive in HTLV-1 PCR. These two PCR-positive samples which were quantified in real-time PCR showed that fewer than five in 10(6) cells were HTLV-1 infected. We succeeded in amplifying and sequencing the 5' end of the provirus from the blood of the PCR-positive MFR by seminested PCR. A positive result was also obtained in this test. Phylogenetic tree analyses revealed a high homology of this sequence with other HTLV-1 sequences from the Middle East. The above PCR-positive MFR was the brother of a PCR-negative patient with MF.

CONCLUSIONS

These findings demonstrate that HTLV-1 is probably not the aetiological agent of MF. However, it may play a role in immunosuppression and in the spreading of the disease.

Disability profile of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis using the Functional Independence Measure (FIM)

STUDY DESIGN

Survey.

OBJECTIVE

To determine the disability profile of a group of patients with human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), using the Functional Independence Measure (FIM) to identify the most affected functional areas.

SETTING

Reference center for HTLV Rio de Janeiro, Brazil.

METHODS

A total of 72 patients (49 female and 23 male), consecutively referred by tertiary care centers, were assessed using the FIM.

RESULTS

The average FIM score was 108 (+/-12 SD) ranging from 58 to 122. The lowest items scores were obtained in locomotion and bladder management. When divided into two groups (above, and below or equal to the average score), there were significant differences (P<0.05) in age at time of assessment, in the degree of muscular power and in low back pain. There were no significant differences in terms of age of onset and duration of the disease.

CONCLUSIONS

The most affected areas in FIM motor items were locomotion (walk and stairs) and bladder management. Age, strength in lower limbs and low back pain interfere with functional activities in patients with HAM/TSP. The duration of the disease is not a significant factor for patient disabilities. The goals of rehabilitation in HAM/TSP patients should target the modifiable factors, such as pain, strength and the neurogenic bladder.

Erectile dysfunction and HTLV-I infection: a silent problem

The human T-lymphotropic virus type I (HTLV-I) is a retrovirus associated with a chronic myelopathy known as HTLV-I-Associated Myelopathy or Tropical Spastic Paraparesis (HAM/TSP). The main objective was to assess the frequency of erectile dysfunction (ED) in HTLV-I-infected individuals from Salvador and other cities from Bahia, Brazil, as well as to verify if sexual dysfunction correlates with urinary symptoms and overall neurological impairment. From January 2001 to April 2004, 218 HTLV-I carriers (111 male and 107 female subjects) had complete clinical, neurological, and urological evaluation. They were assessed using standardized questionnaires to determine urinary complaints (Urinary Distress Inventory) and ED (Brief Male Sexual Function Inventory). Neurological impairment was established by Expanded Disability Status Scale (EDSS) from 0 to 10. HAM/TSP was considered as EDSS> or =2. A total of 17 males had clinically defined HAM/TSP (group 1). From the 94 HTLV-I-infected males, 62 were selected (group 2) and paired by age with patients in group 1. A total of 79 individuals were selected for this study. The age ranged from 35 to 81 y (mean=47.9+/-9.65). The percentage of ED in the studied population was 40.5%. In the HAM/TSP group, ED frequency was 88.2%. The associations among sexual dissatisfaction, erectile dysfunction, urinary symptoms (frequency, nocturia, and urgency) and EDSS> or =2 were statistically significant. In HAM/TSP, there is a slow and progressive degeneration of the lateral funiculus of the spinal cord. HTLV-I-infected individuals present a high frequency of ED and it is closely associated to urinary symptoms and the overall neurological picture. The HTLV-I carriers already had prominent compromise of the sexual activity.

Neurological manifestations in HTLV-I-infected blood donors

The human T-cell lymphotropic virus type 1 (HTLV-I) causes a neurological disease known as HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a minority of infected individuals. Although other neurological outcomes have been described their prevalence is presently unknown. To evaluate the frequency and characteristics of neurological involvement in a population of HTLV-I-infected blood donors we investigated 196 HTLV-I positive and 196 negative blood donors from a blood center of Rio de Janeiro, Brazil. Individuals with abnormalities at the neurological examination were examined by three neurologists, and when pertinent, additional neurological investigations were performed. Descriptive analysis, Student's t-test and chi2 test were employed for statistical analysis. Neurological abnormalities were found in 71 (36.2%) of the HTLV-I positive blood donors and in only 29 (14.8%) of the HTLV-I negative donors (OR = 2.54, 95% CI = 1.67-3.59, p = 0.000002). Cases of myelopathy, motor neuron disease and myopathy were only found in the HTLV-I positive group. In addition, peripheral neuropathy (PN) was significantly more frequent in the positive group (p = 0.015). In summary, our data suggest that HTLV-I-infected individuals exhibit a wide variety of neurological manifestations apart from the classical picture of HAM/TSP.

Dermatological findings of human T lymphotropic virus type 1 (HTLV-I)-associated myelopathy/tropical spastic paraparesis

Dermatological findings for patients with human T lymphotropic virus type 1(HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) were investigated and were compared with dermatological findings for a control group. Only xerosis, cutaneous candidiasis, and palmar erythema were significantly associated with HAM/TSP. Histopathological patterns of cutaneous lymphoma were seen in 25% of 32 patients who underwent biopsy, and, thus, the cutaneous alterations in HAM/TSP can be classified into nonspecific lesions, infectious lesions, immune-inflammatory-mediated lesions, and premalignant or malignant lesions.

Inhibitory effect of extracts of Brazilian marine algae on human T-cell lymphotropic virus type 1 (HTLV-1)-induced syncytium formation in vitro

Extracts from four species of Brazilian marine algae collected from the Rio de Janeiro State coast were screened to determine the inhibitory effect on HTLV-1-induced syncytium formation. Before performing the syncytium inhibition assay the 50% cytotoxic dose (CyD50) of the algal extracts was evaluated. The antiviral test was carried out in HeLa cells co-cultured with HTLV-I infected T-cell line (C91/PL cells) in the presence of marine algal extracts in the concentration inferior to that corresponding to the CyD50. It was observed that co-cultured cells exposed to Ulva fasciata extract showed 60.2% syncytium inhibition at a concentration of 2.5%. At 5% concentration, Sargassum vulgare and Vidalia obtusiloba extracts presented 78.8 and 76% syncytium inhibition, respectively. The best inhibitory activity was observed with Laminaria abyssalis that presented 100% syncytium inhibition at a concentration of 2.5%. This work shows that extracts of marine algae, mainly L. abyssalis extract, are able to inhibit the cell-to-cell contact essential for the spreading of the virus and could be useful to prevent the infection.

Inflammatory myopathy on HTLV-I infection: case report

We describe a 41 years old woman who 17 years ago presented hypotonia and proximal muscular weakness in the upper and lower limbs. On neurological examination, the biceps, triceps and Achilles reflexes were absent; the brachioradialis reflexes were decreased and the patellar reflexes were normal. There was bilateral Babinski sign. The remainder of the neurological examination was unremarkable. In the investigation a myopathic pattern was found in the electromyography. The nerve-conduction study was normal; a ELISA method for HTLV-I antibodies was positive in the blood and in the cerebral spinal fluid. The muscle biopsy showed inflammatory myopathy, compatible with polymyositis. This paper focuses the polymyositis in the beginning of an HTLV-I infection case.

[Tropical spastic paraparesis/HTLV-I associated myelopathy. Report of 2 cases diagnosed in Cuiabá, Mato Grosso, Brazil]

We describe two cases of tropical spastic paraparesis/HTLV-I associated myelopathy, according to the criteria of World Health Organization-1989. These are the first cases diagnosed in Cuiabá (Mato Grosso State, Brazil). One of them had a good response with the treatment with prednisone.

Syringohydromyelia or HTLV-I-associated myelopathy/tropical spastic paraparesis. A diagnostic challenge. Case report

Human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common chronic myelopathy in Brazil. We present the case of a 53 year old man that fulfilled the diagnostic criteria for HAM/TSP but had at the magnetic resonance imaging (MRI) of the spinal cord evidences of syringohydromyelia at the C6-C7 and D2-D7 levels along with Chiari type I malformation. The clinical picture was more typical of HAM/TSP than of syringohydromyelia, which was probably asymptomatic. The present case clearly demonstrates that serology and neuroimaging should be always used together. We conclude that, specially in places where HTLV-I is endemic, every patient with a spastic paraparesis, even with a radiological picture suggestive of a structural spinal cord lesion, should have a screening test for HTLV-I. The clinical picture must dictate the final direction of the diagnosis.

HTLV-I-associated myelopathy/tropical spastic paraparesis in Brazil: a nationwide survey. HAM/TSP Brazilian Study Group

To study the epidemiology of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Brazil, we conducted a nationwide survey between March 1994 and April 1995. Five centers from three regions of the country participated, enrolling 163 patients. Most patients came from the northeastern and southeastern regions (93.2%). Most enrollees were white women, 42.9% and 64.4%, respectively. The most common risk factors for infection included a history of venereal diseases (30.6%) and blood transfusion (21.6%). The median age at the beginning of the disease was 42 years. The main neurologic findings were spastic paraparesis, widespread brisk tendon jerks, bilateral Babinski's sign, and bladder dysfunction. Some interregional differences reached statistical significance. The ratio of females over males increased from south to north. In addition, in both southern and southeastern regions, whites prevailed, whereas in the northeast, mulattos predominated. This follows the normal distribution of the population in these regions. A significantly higher rate of venereal diseases was found in the southeast compared with the other regions studied. A history of intravenous drug use was more frequent among patients as the sample moves south. Finally, a fluctuating course of the disease was proportionally more frequent in the southern region.

Ethnic cluster of HTLV-I infection in Israel among the Mashhadi Jewish population

A high prevalence of human T-lymphotropic virus type I (HTLV-I) infection among Israeli Jews was previously reported. In the present study, screening for HTLV-I of Israeli Jews was expanded to 10 ethnic groups. HTLV-I antibodies were tested by the particle agglutination assay, ELISA, and by Western blot as a confirmatory method. The HTLV-I proviral genome was tested by nested PCR with tax primers (SK43/SK44 and Tr101/Tr102). The PCR tests were carried out in all seropositive subjects and the seronegative family members of the seropositives subjects in the Iranian population. Sixty-eight of the 1,679 subjects (4.1%) were found to be seropositive. The Jews originating from Mashhad had the highest infection rate of 60/306 (20%). Of the 479 Iranian non-Mashhadi Jews, 6 (1.3%) were seropositive. Of the 894 non-Iranian Israelis, only 2 (0.2%) were seropositive. HTLV-I proviral DNA was found in the peripheral blood lymphocytes of 66 out of 68 seropositive subjects and 6 out of 75 seronegative subjects. Sixty out of 123 (49%) Mashhadi Jews and 8 out of 14 (57%) non-Mashhadi Iranian Jews were PCR-positive. Three out of three seropositive non-Iranian Israelis were PCR positive. One non-Iranian Israeli (who originated from Ukraine) without family connections to the Iranian Jews was also PCR-positive. One hundred eighteen saliva samples (84 from subjects of Mashhadi origin, 31 from Iranian origin, and 4 of other origins) were also screened. Antibodies for HTLV-I were found in 23 out of 46 saliva samples from the individuals with particle agglutination (PA) and/or PCR-positive findings in blood. Twenty out of 23 PA-positive saliva samples also contained the proviral DNA. It is concluded that HTLV-I infection in Israel is mainly limited to Jews originating from Iran (most of them from Mashhad) and their family members.

HTLV-I and HTLV-II infections in hematologic disorder patients, cancer patients, and healthy individuals from Rio de Janeiro, Brazil

To clarify the seroprevalence of human T-cell lymphotropic virus type I (HTLV-I) among hematologic and cancer patients in the State of Rio de Janeiro, Brazil, we investigated sera from 2430 individuals from the following groups: 152 patients with T-cell diseases, 250 with B-cell disorders, 67 with myeloid leukemia, 41 with Hodgkin's disease, 351 with a history of multiple blood transfusions, 235 patients with solid tumors of different types, and 109 family members of HTLV-I-infected patients. Antibodies to HTLV-I were screened by enzyme-linked immunosorbent assay or particle agglutination assays (or both). Repeatedly reactive samples were tested by Western blot and polymerase chain reaction assay to differentiate HTLV-I from HTLV-II. We found an increased seroprevalence rate of HTLV-I among those with lymphoid malignancies, mainly in T-cell diseases (28.9%), and these results were important in characterizing 44 cases of adult T-cell leukemia/lymphoma. We confirmed the presence of HTLV-I and HTLV-II infections in blood donors (0.4% and 0.1%, respectively), in patients exposed to multiple blood transfusions (10.2% and 0.8%, respectively), and in 30 (27.5%) of 109 family members of HTLV-I- or HTLV-II-infected patients. We also confirmed the high rate occurrence of adult T-cell leukemia/lymphoma among lymphoproliferative disorders in Rio de Janeiro, Brazil.

[Tropical spastic paraparesis: a necessary redefinition]

The author disserts on the definition of Tropical Spastic Paraparesis since its first description up to the etiological involvement of HTLV-1 in part of the cases. According to him the basic nucleus of the syndrome consists of a paraparesis with pyramidal signs (spasticity and hyperreflexia) with variable sensory and sphincter symptoms. The retroviral etiology by HTLV-1 is one of the variable elements of the condition. He aims at preventing conceptual distortions in the description of this condition.

Tropical spastic paraparesis/HTLV-I-associated myelopathy in Brazil

Brazil, the largest Latin American country, is highly heterogeneous, both demographically and socioeconomically. The overall human T-cell lymphotropic virus type I (HTLV-I) seroprevalence among blood donors is approximately 0.45%. These rates are highly variable, from 0 to 1.8%. Since 1989, many series of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM) cases have appeared in the literature, with high variation in the prevalence of HTLV-I among TSP patients (14.7-57%). The main clinical features of Brazilian TSP/HAM are similar to those in other endemic countries, but sensory signs are more frequent. Recently, the presence of peripheral nerve and muscular involvement has been characterized. The first nationwide study on the disease has been recently completed: it enrolled 163 patients and concluded that TSP/HAM is common in Brazil, mainly in the northeast and southeast regions; it predominates among women and whites; the most important risk factors for infection are sexual promiscuity and blood transfusion; and, although a remarkably uniform disease throughout the country, some statistically significant differences were detected, such as a higher proportion of females over males in the northeast region, a higher proportion of whites the southeast and the south and mulattos in the northeast, and, finally, a high rate of venereal diseases in the southeast region and of intravenous drug use in the south. Brazil seems to be a perfect setting for future epidemiologic, clinical, basic, and therapeutic studies on TSP/HAM.

HTLV-I associated myelopathy/tropical spastic paraparesis. Report of the first cases in Rio Grande do Sul, Brazil

The HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP), a myelopathy with predominant involvement of the pyramidal tract with minimal sensory loss and associated with HTLV-I infection, endemic in tropical areas, has been identified in four patients in Porto Alegre (RS, Brazil), a temperate zone.

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Human T-lymphotropic virus type I and type II infections and correlation with risk factors in blood donors from São Paulo, Brazil

BACKGROUND

Little is known about the prevalence of and risk factors for human T-lymphotropic virus type I and type II (HTLV-I, HTLV-II) infections in Brazil.

STUDY DESIGN AND METHODS

Sera from 17,063 healthy Brazilian donors were screened by enzyme-linked immunosorbent assay for antibody to HTLV-I/II between August 1991 and July 1993. Repeatedly reactive samples were confirmed by Western blot, and discrimination between HTLV-I and HTLV-II was made by polymerase chain reaction or synthetic peptide enzyme-linked immunosorbent assay. A univariate analysis was performed on demographic and serologic data.

RESULTS

HTLV-I infection was demonstrated in 83 percent of the 30 donors with reactive serologic tests (0.15% of the total tested [17,063]; 95% CI, 0.09-0.20) and HTLV-II infection in 17 percent (0.03% of the total tested [17,063]; 95% CI, 0.01-0.05). HTLV-I-positive donors were more likely than reference groups to be of Asian ethnicity (odds ratio [OR] 15.1; reference group: whites), more than 50 years old (OR 4.2; reference group: 20-29 years old), and positive for antibody to hepatitis C virus (anti-HCV) (OR 21.8) or to hepatitis B core (antigen) (anti-HBc) (OR 5.7). HTLV-II showed a significant association with anti-HCV (OR 75.2) and anti-HBc (OR 21.8). Eleven of the 25 HTLV-I-positive donors were counseled. Family origin in endemic areas of Japan (n = 4), prior blood transfusion (n = 3), or sexual contact with prostitutes (n = 1) were the risk factors reported by 8 donors. In 3 white men, no risk factors could be identified.

CONCLUSION

Both HTLV-I and HTLV-II occur among Brazilian blood donors. HTLV-I is associated with Asian ethnicity, greater age, and the presence of anti-HCV and anti-HBc. Three HTLV-I-positive donors had a history of blood transfusion, which emphasizes the need for HTLV-I/II screening in Brazil.

HTLV-negative and HTLV type I-positive tropical spastic paraparesis in northeastern Brazil

A type-specific serological survey among 1042 random nonneurological outpatients in two cities in the state of Ceara (northeastern Brazil) shows a low prevalence of HTLV-I (0.34% in Fortaleza; 0.44% in Crato) and of HTLV-II (0.34% in Fortaleza; 0% in Crato). Among 62 chronic myelopathic patients seen in Fortaleza 27 patients were found with clinical features of tropical spastic paraparesis (TSP); 10 of 27 were found HTLV-I seropositive (37%; 95% confidence limits, 19-58%). Proviral genome detection by polymerase chain reaction in 5 seropositive and 12 seronegative patients confirmed the serological findings. This excludes HTLV-I or -II infection as a cause in the seronegative TSP patients. The HTLV-positive and -negative patients did not differ clinically and by history, except that seropositives had a longer mean disease duration, a female predominance, and a higher proportion of white Caucasians. In this population with low HTLV-I and HTLV-II prevalences, HTLV-negative TSP is at least as frequent as the HTLV-I-associated TSP.

Brazilian studies on tropical spastic paraparesis. A meta-analysis

Tropical spastic paraparesis (TSP) is a chronic progressive myelopathy and in most of the cases has a retroviral (HTLV-1) etiology, when it is denominated HTLV-1 associated-mielopathy (HAM/TSP). Around 433 cases of TSP have been described in Northeast and Southeast Brazil. Among these cases, 157 (36.2%) are HTLV-1 positive and 276 (63.7%) are negative. Their mean age is 43.8 years with a slight predominance of females and mulattoes, although white patients are also numerous. Clinically all patients exhibit a spastic paraparesis with variable sphincter and sensory disturbance. Pain and autonomic symptoms seem to be expressive in the HTLV-1 positive HAM/TSP Brazilian patients.

[Tropical spastic paraparesis in the tropics and Brazil. A historical analysis]

The tropical spastic paraparesis (TSP) is a chronic myelopathy, predominant in the tropics, recently known to be of retroviral origin (HTLV-I). This paper aims at delineating the clinico-etiological evolution of this entity. The historical analysis of it showed that the TSP has had, along decades, many different denominations and the discovery of the retroviral origin for some of them has stimulated new paths of research and epidemiological interest in the tropics and Brazil.

Spastic paraparesis associated with human T-lymphotropic virus type I: a clinical, serological, and genomic study in Iranian-born Mashhadi Jews

The Mashhadi-Jewish community originating in Iran is a closed and ethnically segregated population with a unique history and a high rate of intrafamilial marriage among its members. A high risk of infection by human T-lymphotropic virus type I (HTLV-I) and of adult T-cell leukemia associated with such infection was found in this population. HTLV-I is also associated with a syndrome of progressive spastic paraparesis. We therefore evaluated the occurrence of HTLV-I infection and spastic paraparesis in Mashhadi-born Iranian Jews who immigrated to Israel. We examined 83 Mashhadi-born subjects (52 women, 31 men; mean age, 61 +/- 15.5 years) and 73 age-matched non-Mashhadi Iranian-born Jews. Blood samples were tested for HTLV-I antibodies by particle agglutination test. The polymerase chain reaction (PCR) was used to detect HTLV-I proviral DNA sequences from peripheral blood mononuclear cells. Fifteen Mashhadi-born Jews (18%) were both seropositive and PCR-positive for HTLV-I. Four HTLV-I-seronegative subjects were found to be positive for HTLV-I proviral DNA by PCR. Of the 19 HTLV-I-infected subjects (11 women, 8 men; mean age, 59 +/- 16 years), 13 (68%) had spastic paraparesis of varying severity. There were no signs of myelopathy in the Mashhadi-born subjects who were negative for HTLV-I proviral DNA by PCR. None of the non-Mashhadi Iranian Jews was seropositive or PCR-positive for HTLV-I proviral DNA, or had clinical signs of spastic paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Human T-cell leukaemia virus type I and neurological disease

Tropical spastic paraparesis is thought to be caused either directly by human T-cell leukaemia virus type I (HTLV-1), or by the immune response to the virus. Recent work has identified differences between tropical spastic paraparesis patients and healthy carriers of HTLV-I, both in the virus and in the host's T-cell response to the virus. These differences may provide clues to the pathogenesis of tropical spastic paraparesis.

Intravenous methylprednisolone in HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP)

HTLV-I (Human T-lymphotropic virus type I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immunomediated myelopathy induced by the HTLV-I. Some patients, specially those from Japan, seem to have a good response to steroid treatment. However, this has not been found in other regions of the world. High dose intravenous methylprednisolone has been used with success in patients with relapses of multiple sclerosis (MS), another autoimmune disease of the central nervous system. To test the effectiveness of methylprednisolone in patients with HAM/TSP, we devised an open trial in 23 patients. We found a very limited benefit of this form of treatment in these patients. Only one patient, who had the shortest disease duration (five months) in the whole group, showed a sustained benefit. We speculate that those patients with a shorter history, with presumably less demyelination and more inflammatory lesions, would show a better response to immunosuppressive treatments.

Clinical and demographic features of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil

In Rio de Janeiro (RJ) most cases of paraparesis of obscure origin are associated with the human T-cell lymphotropic virus type I (HTLV-I). Thirty-four consecutive patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) from RJ were evaluated. Most patients came from low socio-economic levels. There was no difference in terms of gender. The main affected racial group was white. A history of sexually transmitted diseases was a major risk factor for HAM/TSP and a positive serology for syphilis was found in 26.5% of the patients. The major clinical findings were of a spastic paraparesis with generalized brisk tendon jerks and bilateral Babinki's sign. Sensation was abnormal in 25 patients (73.5%) and five (14.7%) had a sensory level. Three patients (8.8%) had optic atrophy. The cerebrospinal fluid showed a lymphocytic pleocytosis with a mean total protein content of 0.4 g/litre, and an increased intrathecal IgG synthesis in 59.4% of patients. HAM/TSP and multiple sclerosis (MS) occur indigenously in RJ and some HAM/TSP cases can be sometimes confused with MS. Therefore we propose that, in places where MS coexist with HAM/TSP, HTLV-I antibodies should be sought routinely in those MS suspected cases with prominent spastic paraparesis.

Spastic paraparesis of obscure origin. A case-control study of HTLV-I positive and negative patients from Rio de Janeiro, Brazil

In order to find clinical findings that could significantly discriminate between HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-I negative spastic paraparesis of obscure origin (SPOneg) prior to serological testing, and to find risk factors significantly associated with HAM/TSP we devised a case-control study. Sixty consecutive SPO patients were studied without previous knowledge of their HTLV-I serological status. Thirty-four (56.7%) turned out to be HTLV-I positive and 26 (43.3%) HTLV-I negative. HTLV-I infected patients tended to have more commonly motor and bladder disturbances at the beginning of their illness and a disease that was still in progression at the time of the examination. Bladder dysfunction, constipation and penile impotence, and more widespread pyramidal signs, were also more frequent during the whole course of their illness. Likewise, an increased intrathecal synthesis of IgG was found more often in the HTLV-I positive group. The only risk factor for HTLV-I infection significantly associated to HAM/TSP was a prior history of sexually transmitted diseases. These results suggest that, at least in RJ, HAM/TSP might be mainly sexually acquired.

The epidemiology of myelopathy associated with human T-lymphotropic virus 1

A progressive spastic myelopathy is one of the principal manifestations of the human T cell lymphotropic virus type 1. Recent research is reviewed on the geography and epidemiology of this specific form of tropical spastic paraparesis. First recognized in the Caribbean, Colombia and Japan, it is now also confirmed as a major neurological problem in areas of eastern Brazil, western equatorial Africa, Natal and Seychelles, with other scattered foci world-wide. Accurate surveys call for sophisticated techniques including polymerase chain reaction amplification. The only defined modes of spread are by breast feeding, sexual contact and blood cell infusion. The onset of neurological disease is associated with high antibody titres and a high rate of spontaneous T lymphocyte proliferation. Molecular analysis has revealed no nucleotide sequence variation in cases with or without myelopathy. In non-transfusion cases the clinical attack rate is low with a very long latent period, but there are unexplained regional differences and familial cases are an important exception. Current research is focused on possible local, ethnic, or genetic co-factors.