Elderly people with human T-cell leukemia virus type 1-associated myelopathy present an early impairment in cognitive skills / Idosos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1apresentam comprometimento precoce em habilidades cognitivas

Abstract Background Cerebral changes occur in individuals with human T-cell leukemia virus type 1 (HTLV-1 )-associated myelopathy (HAM) and seem to predominate in subcortical areas. Little is known about the cognitive decline in the elderly living with HTLV-1. Objective To evaluate the cognitive aging of individuals infected with HTLV-1 aged ≥ 50 years. Methods This is a cross-sectional study of former blood donors infected with HTLV-1 who have been followed in the cohort of the Interdisciplinary Research Group on HTLV-1 since 1997. The groups of study consisted of 79 HTLV-1 infected individuals aged ≥ 50 years, with 41 of them presenting symptomatic HAM and 38 being asymptomatic carriers, and 59 seronegative individuals (controls) aged ≥ 60 years. All were submitted to the P300 electrophysiological test and neuropsychological tests. Results Individuals with HAM presented delayed P300 latency in relation to the other groups, and this latency delay increased progressively with aging. The performance of this group in the neuropsychological tests was also the worst. The HTLV-1- asymptomatic group performance was similar to that of the control group. Conclusions Individuals with HAM presented cognitive decline that progressed with aging and, although HTLV-1-asymptomatic carriers appear to present cognitive aging similar to that of healthy elderly people, concern about a subclinical cognitive impairment is warranted in this population.

Resumo Antecedentes Alterações cerebrais ocorrem em indivíduos com mielopatia associada ao vírus da leucemia de células T humanas tipo 1 (HTLV-1) (HAM) e parecem predominar em áreas subcorticais. Pouco se sabe sobre o declínio cognitivo em idosos vivendo com HTLV-1. Objetivo Avaliar o envelhecimento cognitivo de indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos. Métodos Trata-se de um estudo transversal com ex-doadores de sangue infectados pelo HTLV-1 acompanhados na coorte do Grupo Interdisciplinar de Pesquisa em HTLV-1 há 20 anos. Os grupos de estudo foram compostos por 79 indivíduos infectados pelo HTLV-1 com idade ≥ 50 anos, sendo que 41 apresentavam HAM e 38 eram portadores assintomáticos, e 59 indivíduos soronegativos (controles) com idade ≥ 60 anos. Todos foram submetidos ao teste eletrofisiológico P300 e testes neuropsicológicos. Resultados Indivíduos com HAM apresentaram atraso na latência do P300 em relação aos demais grupos, e esse atraso de latência aumentou progressivamente com o envelhecimento. O desempenho desse grupo nos testes neuropsicológicos também foi o pior. O desempenho do grupo HTLV-1- assintomático foi semelhante ao do grupo controle. Conclusão Indivíduos com HAM apresentaram declínio cognitivo que progrediu com o envelhecimento e, embora os portadores assintomáticos do HTLV-1 pareçam apresentar envelhecimento cognitivo semelhante ao dos idosos saudáveis, justificase a preocupação com um comprometimento cognitivo subclínico nessa população.

Silencioso e negligenciado: o que se sabe após quatro décadas do descobrimento do HTLV-1? / Silent and neglected: what is known after four decades of the discovery of the HTLV-1? / Silencioso y descuidado: ¿qué se sabe después de cuatro décadas del descubrimiento del HTLV-1?

O vírus linfotrópico T humano tipo 1 (HTLV-1) foi o primeiro retrovírus humano descoberto, descrito pela primeira vez há 41 anos. Esse retrovírus está associado ao desenvolvimento de duas doenças graves: a leucemia/linfoma de células T do adulto (ATLL) e a mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP). Este trabalho teve como objetivo analisar as atualizações sobre o HTLV-1, destacando os aspectos clínicos, os avanços e as limitações no tratamento e na prevenção da infecção pelo HTLV-1. Para isso, foi realizada uma revisão integrativa, por meio de coleta de dados nas plataformas PubMed, LILACS e SciELO, entre março e abril de 2021. Foram incluídos 61 artigos de diferentes países. O Brasil foi o país com maior número de publicações na área: 12. Os resultados obtidos mostram que existem avanços importantes no que diz respeito ao tratamento e à prevenção da infecção pelo HTLV-1. No entanto, a falta de estudos específicos sobre o vírus, que abordem os aspectos clínicos da infecção, foi um fator limitante para este estudo, o que reforça a necessidade de investimento em novas pesquisas sobre o tema.

The Human T-lymphotropic Virus 1 (HTLV-1) was the first human retrovirus discovered, described for the first time 41 years ago. This retrovirus is associated with the development of two serious diseases: adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV-1-associated myelopathy (HAM/TSP). This study aimed to analyze the updates about HTLV-1, highlighting the clinical aspects, advances, and limitations in the treatment and prevention of HTVL-1 infection. To this end, an integrative review was carried out, with data collection on PubMed, LILACS, and SciELO platforms, between March and April 2021. A total of 61 articles from different countries were included. Brazil was the country with the largest number of publications in the area: 12. The results showed effective advances regarding treating and preventing HTLV-1 infection. However, the lack of specific studies about the virus, which address the clinical aspects of the infection, was a limiting factor for this study, which reinforces the need for investment in new research about this topic.

El virus linfotrópico T tipo 1 humano (HTLV-1) fue el primer retrovirus humano descubierto y se describió por primera vez hace 41 años. Este retrovirus está asociado con el desarrollo de dos enfermedades graves: leucemia/linfoma de células T del adulto (ATLL) e mielopatía asociada a HTLV-1/paraparesia espástica tropical (HAM/TSP). Este estudio tuvo como objetivo analizar las actualizaciones sobre HTLV-1, destacando los aspectos clínicos, los avances y limitaciones en el tratamiento y prevención de la infección por HTLV-1. Para ello, se realizó una revisión integradora, a través de la recolección de datos en las plataformas PubMed, LILACS y SciELO entre marzo y abril de 2021. Se incluyeron 61 artículos de diferentes países. Brasil fue el país con mayor número de publicaciones en el área: 12. Los resultados obtenidos muestran que existen avances efectivos en cuanto al tratamiento y prevención de la infección por HTLV-1. Sin embargo, la falta de estudios específicos sobre el virus que aborden los aspectos clínicos de la infección fue un factor limitante para el presente estudio, lo que refuerza la necesidad de invertir en nuevas investigaciones sobre este virus.

Mielopatía asociada con infección por HTLV-1: paraparesia espástica tropical / Myelopathy associated with HTLV-1 infection: tropical spastic paraparesia

RESUMEN La mielopatía asociada con infección por HTLV-1 o paraparesia espástica tropical (MAH/PET) es una enfermedad crónica degenerativa del sistema nervioso central que afecta principalmente a la médula espinal. Está asociada a la infección por el virus linfotrópico humano tipo 1 (HTLV-1) que pertenece a la familia Retroviridae. América Latina, Asia y África Subsahariana son zonas endémicas de infección por HTLV-1 y MAH/ PET, entre el 2 % y el 17 %, la mayoría asintomáticos. Colombia tiene una alta prevalencia y en especial en su costa pacífica. En las mujeres la infección por HTLV-1 es más prevalente que en los hombres sin que sea clara la causa; se transmite por transfusiones sanguíneas (principalmente de sangre completa), lactancia materna o relaciones sexuales, que es la forma de transmisón más común en pacientes con MAH/PET. La MAH/PET se presenta principalmente en adultos, su periodo de incubación hasta el desarrollo de síntomas varía de dos años hasta décadas. Las principales manifestaciones clínicas de esta enfermedad son la paraparesia y espastici-dad lentamente progresiva que afecta la marcha, asociada con síntomas de esfínteres, como vejiga neurogénica o estreñimiento. Para su diagnóstico se requiere resonancia magnética (RM) de cerebro y médula espinal y la prueba de Elisa, las más usada, con confirmación mediante western blot (WB). En la actualidad no existe un tratamiento específico para la MAH/PET. En el futuro, el uso de biomarcadores ayudará a la detección temprana de la enfermedad e incluso como posible diana terapéutica.

SUMMARY Myelopathy associated with HTLV-1 infection or tropical spastic paraparesis (MAH / PET) is a chronic degenerative disease of the Central Nervous System that mainly affects the spinal cord. It is associated with infection by human lymphotropic virus type 1 (HTLV-1) that belongs to the Retroviridae family. Latin America, Asia and Sub-Saharan Africa are endemic areas of infection by HTLV-1 and MAH / PET between 2 % and 17 %, most asymptomatic. Colombia has a high prevalence and especially on its Pacific coast. In women, HTLV-1 infection is more prevalent than in men without the cause being clear, it is transmitted by blood transfusions (mainly whole blood), breastfeeding and / or sexual intercourse, which is the most common form of transmission in patients with MAH / PET. MAH / PET occurs mainly in adults, its incubation period until the development of symptoms varies from 2 years to decades. The main clinical manifestations of this disease are slowly progressive paraparesis and spasticity affecting gait, associated with sphincter symptoms, such as neurogenic bladder or constipation. For its diagnosis, magnetic resonance imaging (MRI) of the brain, spinal cord and the most used ELISA test are required with confirmation by western blot (WB). Currently there is no specific treatment for HAM / PET. In the future, the use of biomarkers will help early detection of the disease and even as a possible therapeutic target.

Alterações sensoriais em indivíduos com HTLV-1: revisão sistemática / Sensorial changes in individuals with HTLV-1: systematic review

Introdução: A função sensorial é reconhecida como precursora da recuperação do movimento, sendo assim, os sintomas apresentados por pessoas com HTLV-1 podem trazer prejuízo na realização de atividades funcionais Objetivo: Sistematizar o conhecimento sobre alterações sensoriais em pacientes com HTLV-1. Metodologia: Trata-se de uma revisão sistemática, com a busca primária dos artigos realizada nas bases de dados Medline, via biblioteca virtual Pubmed, sendo incluídos estudos observacionais que abordaram a alteração sensorial em indivíduos com HTLV-1. A estratégia de busca foi conduzida de forma independente por dois pesquisadores e as divergências resolvidas por consenso. Resultados: Foram encontrados 44 estudos na busca primária, e destes foram incluídos quatro estudos que abordaram a alteração sensorial em indivíduos com HTLV-1, com um total de 240 participantes. Todos os artigos foram classificados como baixo risco de viés no que diz respeito à descrição da questão do estudo, resultados e discussão. Conclusão: identificou-se uma alta prevalência de dor e alteração na sensibilidade vibratória em relação às outras disfunções sensoriais, no entanto, a escassez de trabalhos publicados acerca deste tema sugere que novas abordagens sejam feitas mostrando uma grande lacuna de conhecimento a ser explorada. [AU]

Background: Sensory function is recognized as a precursor of the movement recovery. Therefore, the symptoms presented by people with HTLV-1 can result in impairment in the performance of functional activities. Aim: To systematize knowledge about sensory alterations in patients with HTLV-1. Methods: This is a systematic review, with the primary search of the articles carried out in the Medline databases, via the Pubmed virtual library, including observational studies that addressed the sensory alteration in individuals with HTLV-1. The search strategy was conducted independently by two researchers and the divergences resolved by consensus. Results: A total of 44 studies were found in the primary search, including four studies addressing sensory impairment in individuals with HTLV-1, with a total of 240 participants. All articles were classified as low risk of bias regarding the description of the study question, results and discussion. Conclusion: We identified a high prevalence of pain and altered vibratory sensitivity in relation to other sensory disorders, however, shortage of published works on this topic suggests new approaches are made showing a large knowledge gap to be explored. [AU]

Impacto da infecção por HTLV-1 nas manifestações clínicas e no tratamento de pacientes com estrongiloidíase / Impact of HTLV-1 infection on clinical presentations and treatment of strongyloidiasis patients

A estrongiloidíase é uma enfermidade que acomete cerca de 100 milhões de pessoas em todo mundo. Essa parasitose apresenta alta prevalência e tem maior gravidade clínica entre indivíduos imunossuprimidos, principalmente aqueles portadores do vírus linfotrópico de células T humana tipo 1 (HTLV). Este fato torna a coinfecção por esse vírus em pacientes parasitados por Strongyloides stercoralis um grave problema de saúde pública. O presente estudo teve por objetivo revisar os estudos sobre coinfecção por HTLV/S. stercoralis. Foi realizada busca eletrônica completa de dados disponíveis sobre a coinfecção entre o vírus e S. stercoralis. As publicações foram capturadas a partir das bases de dados PubMed e SciELO, sendo utilizados os seguintes descritores "vírus linfotrópico de células T humanas tipo 1", "HTLV-1", "S. stercoralis" e "estrongiloidiase". A infecção por HTLV em pacientes parasitados representa fator de risco para o desenvolvimento de estrongiloidíase grave e, nesses indivíduos, o tratamento recomendado deve ser realizado e monitorado para garantir o sucesso terapêutico.(AU)

Strongyloidiasis is a disease that affects approximately 100 million people worldwide. This parasitosis is highly prevalent and more clinically severe among immunosuppressed individuals, particularly those with Human T-lymphotropic virus 1 (HTLV-1). This fact makes the co-infection with this virus in patients parasitized by Strongyloides stercoralis a serious public health problem. The present study aimed at reviewing the studies of co-infection with HTLV/S. stercoralis. A complete electronic search for available data about the co-infection of the virusand S. stercoralis was performed. The publications were obtained from the databases PubMed and SciELO, with the following descriptors being used: "Human T-lymphotropic Virus type 1, "HTLV-1", S. stercoralis, and "strongyloidiasis". The infection with HTLV in infected patients is a risk factor for the development of severe strongyloidiasis, and for these individuals the recommended treatment should be performed and monitored to ensure therapeutic success.(AU)

Case for diagnosis. Infective dermatitis associated with HTLV-1: differential diagnosis of atopic dermatitis

Abstract: Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study / Programa de exercícios domiciliares em indivíduos com PET/MAH: um estudo de viabilidade e efetividade

ABSTRACT Objective To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Methods Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. Results MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. Conclusions The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.

RESUMO Objetivo Investigar a viabilidade e eficácia de um programa de exercícios domiciliares (PED) em indivíduos com PET/MAH. Métodos 23 indivíduos com PET/MAH divididos em dois grupos conforme teste Timed Up and Go - TUG (<20s vs ≥20s) realizaram o PED durante 20 semanas. Desfechos primários – adesão aos exercícios, contração isométrica voluntária máxima dos membros inferiores (CIVM), Índice de Barthel e SF-36. Desfechos secundários – ocorrência de eventos adversos e presença de barreiras à prática de exercícios. Resultados CIVM e componente “Aspectos Sociais” da SF-36 aumentaram significativamente no grupo TUG <20s. Os indivíduos do grupo TUG ≥20s aumentaram significativamente componente “Capacidade Funcional” da SF-36. A adesão ao PED foi de 90%. Foram observados eventos adversos de intensidade leve a moderada relacionados ao PED. Não foram encontrados eventos adversos relacionados à CIVM. Conclusões O PED é viável e eficaz em melhorar a incapacidade e a qualidade de vida de indivíduos com PET/MAH.

HTLV-1-associated infective dermatitis and probable HTLV-1- associated myelopathy in an adolescent female

Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (ID) is a chronic, severe and recurrent eczema occurring during childhood in patients vertically infected with HTLV-1. HTLV-1-associated myelopathy/tropical spastic paraparesia (HAM/ TSP) is slow and progressive. We report the case of an adolescent female from a non-endemic area for HTLV-1 who presents ID and, most likely, associated HAM/TSP.

The Th17/Treg imbalance in HAM/TSP patients / 中国医师杂志

Objective To investigate the imbalance of T helper 17 (Th17) / CD4 + CD25 + regulatory cell (Treg) in HAM/TSP patients.Methods Enzyme linked immunosorbent assay (ELISA) was performed to measure the levels of interleukin (IL-17) and IL-10 in CSF,and flow cytometry to determine the percentage of Th17 and Treg cells in peripheral blood of patients with HAM/TSP.Results There was a significant increase in the level of IL-17 [(4.58 ± 0.70)pg/ml vs (0.76 ± 0.17)pg/ml,P ＜ 0.01] in CSF and the percentage of Th17 cells [(2.00 ± 0.64) ％ vs (0.41 ± 0.24) ％,P ＜ 0.01],but a decrease in the level of IL-10 in CSF and the percentage of Treg cells in peripheral blood of patients with HAM/TSP compared with the control group.The ratio of Th17/Treg cell (0.55 ±0.10 vs 0.06 ±0.03) in the peripheral blood of patients with HAM/TSP increased significantly compared with control group (t =12.11,P ＜0.01).Conclusions The imbalance between Thl7 and Treg cells may play an important role in the pathogenesis of the disease.

Conhecendo o HTLV e suas implicações no atendimento odontológico / Getting to know HTLV and their implications during dental care

Os vírus T Linfotrópico humano representam um grupo de retrovírus que possuem tropismo por linfócitos T e são transmitidos pelas vias parenteral, vertical e sexual. Foram identificados os tipos 1, 2, 3 e 4 sendo que o vírus T Linfotrópico humano -1 tem sido o mais associado ao desenvolvimento de doenças nos pacientes infectados. A estimativa global é de que 15 a 20 milhões de pessoas estejam infectadas pelo vírus T Linfotrópico humano -1. No Brasil o vírus é endêmico, apresentando o maior número absoluto de casos no mundo e sendo incluído na triagem hematológica realizada nos hemocentros. As principais doenças associadas ao vírus T Linfotrópico humano -1 são a leucemia/linfoma de células T do adulto e a paraparesia espástica tropical. A única manifestação bucal associada ao vírus T Linfotrópico humano é o linfoma de células T do adulto, sendo que alguns autores apontam para a possibilidade de pacientes com paraparesia espástica tropical também apresentarem a síndrome de Sjõgren relacionada à infecção pelo vírus. O fato de o vírus T Linfotrópico humano ser um vírus contagioso e com capacidade oncogênica requer a atenção do cirurgião-dentista tanto no manejo odontológico quanto no diagnóstico de possíveis doenças associadas.

The human T-lymphotropic viruses represent a group of retroviruses that possess tropism for T lymphocytes and are transmitted parenterally, vertically and sexually. Four types have been identified, 1, 2, 3 and 4. Type 1 has been most frequently associated with disease in infected individuals. It is estimated that 15 to 20 million people are affected by human T-lymphotropic virus type 1. In Brazil, the virus is endemic, presenting the greatest absolute number of cases in the world and included in blood bank screening tests. The main diseases associated with human T-lymphotropic virus type 1 are adult T-cell leukemia/lymphoma and tropical spastic paraparesis. The only oral manifestation associated with human T-lymphotropic virus is adult T-cell lymphoma. Some authors believe it is possible for some patients with tropical spastic paraparesis to also present virus-related Sjõgren?s syndrome. Since human T-lymphotropic virus is contagious and potentially oncogenic, it demands attention from the dental surgeon not only for dental management but also for diagnosing associated diseases.

Impacto da mielopatia associada ao HTLV/paraparesia espástica tropical (TSP/HAM) nas atividades de vida diária (AVD) em pacientes infectados pelo HTLV-1 / Impact of HTLV-associated myelopathy/T tropical spastic paraparesis (HAM/TSP) on activities of daily living (ADL) in HTLV-1 infected patients

Objetivo: Descrever o desempenho nas atividades de vida diária (AVD) em pacientes infectados pelo HTLV-1 com TSP/HAM e medir o impacto da doença sobre a qualidade de vida dos pacientes. Método: Trata-se de um estudo descritivo, de corte transversal. Um total de setenta e três pacientes com TSP/HAM acompanhados no Centro de HTLV da Escola Baiana de Medicina e Saúde Pública, Salvador, Bahia, Brasil foram selecionados. O índice de independência funcional foi calculada usando o Health Assessment Questionnaire (HAQ). A qualidade de vida foi avaliada incluindo a capacidade funcional, dor e aspecto físico, utilizando do Short-Form Health Survey (SF-36). Resultados: Um total de setenta e três pacientes com TSP/HAM foram avaliados: a idade média foi de 48,9 ± 11,4 anos, e 57 (78,1%) eram mulheres. A duração da doença TSP/HAM foi de 10 a 37 anos em50,7% dos pacientes. Trinta e seis pacientes (49,3%) necessitavam de ajuda de suportes para andar. As pontuações mais baixas no desempenho das AVD foram observadas entre as mulheres e se referiam à locomoção e à mobilidade / (98,2%), ao vestuário (73,7%) e ao auto cuidado (57,9%). O escore de qualidade de vida para o aspecto físico foi 24,2 e o da capacidade funcional foi 27,1. A média de dor foi 41,7. Conclusão: A TSP/HAM afeta negativamente a qualidade de vida e o desempenho nas AVD dos pacientes. Dispositivos de tecnologia assistiva devem ser usados para melhorar a capacidade funcional e a qualidade de vida desses pacientes.

Aim: To describe the performance of activities of daily living (ADL) ofHTLV-1 infected patients with HAM/TSP and to measure the impact of the disease on the patients’ quality of life. Methods: This study is a descriptive,cross-sectional study. A total of seventy-three HAM/TSP patients were enrolled at the HTLV Center of the Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil. The index of functional independence was calculated using the Health Assessment Questionnaire HAQ. The quality of life, including functional capacity, pain, and physical appearance was assessed using the Short-Form Health Survey (SF-36). Results: A total of seventy-three HAM/TSP patients were enrolled with a mean age of 48.9 ± 11.4 years, 57 of whom were (78.1%) women. The duration of HAM/TSP disease was 10 to 37 years (in 50.7% of the patients). Thirty-six patients (49.3%) had a need for walking supports. The lowest ADL performance scores were observed among women and referred to mobility/locomotion (98.2%), dressing (73.7%), and self-care (57.9%) aspects. The quality of life score for the physical aspect was 24.2, and the functional capacity was 27.1. The average for pain was 41.7. Conclusion: HAM/TSP has a negative impact the on the ADL performance of the patients and their quality of life. Assistive technology devices should be used to improve functional capacity and quality of life for these patients.

O vírus linfotrópico de células T humanos tipo 1 (HTLV-1): quando suspeitar da infecção?: [revisão] / Human T cell lymphotropic virus (HTLV)1: when should infection be suspected?: [review]

A infecção pelo vírus linfotrópico de células T humanas (HTLV) ocorre há milhares de anos. No entanto, o conhecimento sobre a sua patogênese é recente. Esse vírus é endêmico em várias regiões do mundo. No Brasil encontra-se presente em todos os estados, com prevalências variadas, sendo estimado cerca de 2,5 milhões de infectados. Fatores genéticos e imunológicos do hospedeiro são os principais responsáveis pelas manifestações clínicas associadas, que podem ser divididas em três categorias: neoplásicas, inflamatórias e infecciosas. Destacam-se a mielopatia associada ao HTLV (HAM/TSP) e a leucemia/linfoma de células T do adulto (ATLL) como as primeiras doenças associadas a esse retrovírus. Posteriormente, inúmeras outras doenças têm sido correlacionadas a esse vírus. Esta revisão atualiza conhecimentos epidemiológicos, fisiopatológicos, terapêuticos e principalmente diagnósticos do HTLV. O objetivo é permitir a suspeita etiológica do HTLV em suas diversas manifestações clínicas, hoje pouco correlacionadas com este agente.

Human T Lymphotropic Virus (HTLV) infection has occurred for thousands of years. However, knowledge about this pathogenesis is recent. This virus is endemic worldwide. In Brazil it is present throughout the country , with different prevalence and about 2 5 million infected. Genetic and immunologic characteristics of the host are chiefly responsible for clinically associated manifestations which may be: neoplasic, inflammatory and infectious diseases. HTLV associated myelopathy (TSP/ HAM) and adult T cell leukemia/lymphoma (ATL) stand out as the first diseases associated to this retrovirus. Further, several diseases have been correlated to this virus. This review updates epidemiologic, physiopathologic, therapeutic and diagnostic knowledge of HTLV. The purose is to orient suspicion of HTLV etiology and several clinically associated manifestations, which currenty are seldom correlated with this virus.

Imunogenética das uveítes / Imunogenetics in the uveítes

Citocinas são moléculas envolvidas na comunicação intercelular nas respostas inflamatória e imune, desempenhando papel relevante nas uveítes. Polimorfismos dos genes responsáveis pela produção de determinadas citocinas têm sido relacionados com a ocorrência e a gravidade de algumas uveítes. Portanto, o presente trabalho tem como objetivo relatar essas possíveis associações, salientando o aspecto individual genético no prognóstico das uveítes.

Cytokines are molecules involved in intercellular communication in immune and inflammatory responses, playing an important role in uveitis. Genetic polymorphisms responsible for the production of certain cytokines have been associated with the occurrence and the severity of uveitis. Therefore, the present study has the purpose of describing these possible associations, pointing out the individual genetic background in the prognosis of uveitis.

Frequent HTLV-1 infection in the offspring of Peruvian women with HTLV-1-associated myelopathy/tropical spastic paraparesis or strongyloidiasis

OBJECTIVES: To describe the frequency of HTLV-1 infection among offspring of mothers who had presented with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), strongyloidiasis, or asymptomatic HTLV-1 infection, and to identify factors associated with HTLV-1 infection. METHODS: In a descriptive study, records were reviewed of HTLV-1-positive women and their offspring who had been tested for HTLV infection at a public hospital in Lima, Peru, from 1989 to 2003. Sons and daughters of women who had presented with strongyloidiasis, HAM/TSP, or asymptomatic infection were eligible for this study. RESULTS: Three hundred seventy subjects were included: 279 were the offspring of 104 mothers presenting with HAM/TSP, 58 were the offspring of 22 mothers with strongyloidiasis, and 33 were the offspring of 26 asymptomatic mothers. Mean age of the offspring at the time of testing was 26 years (standard deviation 12). Nineteen percent of the offspring tested positive for HTLV-1: 6 percent (2/33) of those with asymptomatic mothers, 19 percent (52/279) among the offspring of mothers with HAM/TSP, and 31 percent (18/58) among the offspring of mothers presenting with strongyloidiasis On multiple logistic regression analysis, three factors were significantly associated with HTLV-1: (a) duration of breast-feeding (odds ratio [OR] = 15.1; [4.2-54.1] for 12 to 24 months versus less than 6 months breast-feeding); (b) clinical condition of the mother (OR = 8.3 [1.0-65.3] for HAM/TSP and OR = 11.5 [1.4-98.4] for strongyloidiasis in comparison with offspring of asymptomatic mothers); and (c) transfusion history (OR = 5.5 [2.0-15.2]). CONCLUSIONS: In addition to known risk factors for HTLV-1 transmission (duration of breast-feeding and history of blood transfusion), maternal HAM/TSP and strongyloidiasis were associated with seropositivity among offspring of HTLV-1-infected mothers.

OBJETIVOS: Describir la frecuencia de la infección por HTLV-1 en los hijos e hijas de madres diagnosticadas con mielopatía/paraparesia espástica tropical asociada con el HTLV-1 (M/PET-HTLV-1), estrongiloidiasis o infección asintomática por HTLV-1, e identificar los factores asociados con la infección por HTLV-1. MÉTODOS: Para este estudio descriptivo se revisaron los registros de mujeres positivas a HTLV-1 y de sus hijos evaluados con pruebas para la infección por HTLV en un hospital público de Lima, Perú, entre 1989 y 2003. Eran elegibles para este estudio los hijos y las hijas de las mujeres que se presentaron con estrongiloidiasis, M/PET-HTLV-1 o infección asintomática. RESULTADOS: En el estudio participaron 370 personas: 279 hijos de 104 madres con M/PET-HTLV-1, 58 hijos de 22 madres con estrongiloidiasis y 33 hijos de 26 madres asintomáticas. La edad promedio de los participantes en el momento de su prueba para HTLV era de 26 años (desviación estándar: 12 años). De las personas estudiadas, 19 por ciento resultaron positivas a la infección por HTLV-1: 6 por ciento (2/33) de los hijos de madres asintomáticas, 19 por ciento (52/279) de los hijos de madres con M/PET-HTLV-1 y 31 por ciento (18/58) de los hijos de madres con estrongiloidiasis. Según el análisis de regresión logística múltiple, tres factores se asociaron significativamente con la infección por HTLV-1: a) duración de la lactancia materna por 12_24 meses (razón de posibilidades [odds ratio, OR] = 15,1; intervalo de confianza de 95 por ciento [IC95 por ciento]: 4,2 a 54,1, frente a la lactancia materna por menos de 6 meses); b) que la madre presentara M/PET-HTLV-1 o estrongiloidiasis (OR = 8,3; IC95 por ciento: 1,0 a 65,3 y OR = 11,5; IC95 por ciento: 1,4 a 98,4, respectivamente, en comparación con los hijos de madres asintomáticas); y c) los antecedentes de haber recibido una transfusión sanguínea (OR = 5,5; IC95 por ciento: 2,0 a 15,2). CONCLUSIONES: Además de los factores...

Inmunohistoquímica de los cambios degenerativos del sistema nervioso central en paraparesias esp sticas asociadas al virus linfotrópico humanoTtipol(HTLV-l) / Immunohistochemistry of degenerative changes in the central nervous system in spastic paraparesis associated to human T lymphotropic virus type I (HTLV-I)

Background: Human T lymphotropic virus type I is associated with tropical spastic paraparesis, that is a chronic and progressive disease which damages specially the cortiespinal tracts. The pathogenesis of this degenerative process remains unknown. Aim: To identify histopathological aspects that could suggest a pathogenic hypothesis we studied immunohistochemical features in spinal cords obtained from patients that died due to progressive spastic paraparesis. Patients and Methods: Five males and five females, who died between 1990 and 2000, with a mean age of 52 years and mean disease duration of 8.6, were studied. All had a complete clinical and virological diagnosis. Samples were obtained from the frontal motor cortex and spinal cord (cervical, dorsal and lumbar segments), were fixed in formol (10 percent), included in paraffin, and stained with Haematoxylin and Luxol-fast-blue. Immunohistochemical study was made with anti-neurofilament antibodies 1:100 (M0762, DAKO), anti-APP 1:20 (Rabbit Pre Amyloid protein 51-2700 ZYMED), anti-tau 1:100 (A0024DAKO) and anti-ubiquitine 1:50 (NCL UBIQm Novocastra). Results: All cases had demyelinization and axonal loss in the cortico-spinal tracts; distal and segmental demyelinization of Goll tract; axonal thickening, amyloid precursor protein deposits in the white matter; tau protein aggregation in the spinal cord oligodendrocytes; axonal ubiquitination of sensitive and motor tracts, and subcortical white matter. Neurona! injury was absent. Conclusions: The systematic damage of motor and sensitive tracts of the spinal-cord and the absence of neurona! damage, defines a degenerative process limited to axons. This central axonopathie could be caused by a disturbance of axoplasmic transport.

Dermatite infecciosa associada ao HTLV-I (DIH) infanto-juvenil e do adulto / Infective dermatitis associated with the HTLV-I (IDH) in children and adults

A dermatite infecciosa associada ao HTLV-I (DIH) é um tipo de eczema infectado e recidivante que incide em crianças que adquirem verticalmente a infecção pelo HTLV-I. Inicia-se após os 18 meses de idade. No entanto, existe relato recente de início na vida adulta. As lesões são eritemato-descamativas, infectadas e freqüentemente crostosas. Localizam-se, com maior freqüência, no couro cabeludo, regiões retroauriculares, pescoço e região inguinal, mas podem ser generalizadas. Vêem-se também físsuras retroauriculares, pápulas eritêmato-descamativas e foliculares. Prurido discreto a moderado, secreção nasal crônica e blefaroconjutivite podem ser observados. A DIH sempre se associa à infecção por Staphylococcus aureus e/ou Streptococcus beta hemoliticus. O diagnóstico diferencial clínico deve ser feito com as dermatites atópica e seborréica e, do ponto de vista anatomopatológico, com a psoríase e o linfoma cutâneo de células T. São discutidos os aspectos clínico-imunopatológicos, o diagnóstico diferencial e a evolução da DIH. Considerando a freqüência da DIH em Salvador, aconselha-se que seja feita sorologia para o HTLV-I em todos os casos de eczema severo em crianças e que essa possibilidade diagnóstica também seja considerada em adultos.

Infectious dermatitis associated with HTLV-I (IDH) is a form of infected and recurrent dermatitis which affects children vertically infected with HTLV-I. IDH starts after 18 months of age. The lesions are erythematous-scaly and frequently crusty and are more frequently located on the scalp and on the retroauricular regions, but the lesions may be generalized. Pustules, erythematous-scaly and follicular papulae and retroauricular fissures may also be observed. Children present mild to moderate pruritus, lesions in the nostrils, and blepharoconjunctivitis. IDH is always associated with Staphylococcus aureus infection and/or Streptococcus beta haemolyticus infection. The differential diagnosis with atopic and seborrheic dermatitis can be made clinically. Histologically it is important to make a differential diagnosis with psoriasis and cutaneous T-cell lymphoma. We discuss here the clinical-immuno-pathological aspects, the differential diagnosis, and the evolution of IDH. Considering the frequency of IDH in Salvador, Bahia, we suggest that children with severe eczema be submitted to routine serology for HTLV-I and that IDH be included in the differential diagnosis of dermatitis in adulthood.

Apoptosis and expression of Fas, TNF-? and Bcl-2 in patients’serum and cerebrospinal fluid with HAM/TSP / 中华神经科杂志

Objective To investigate the apoptosis of peripheral blood lymphocyte cells in patients with HAM/TSP and the roles of Fas/FasL system, TNF ? and Bcl 2 protein in occurrence and progression of HAM/TSP Methods The single cell gel electrophoresis (comet assay) was used to detect the apoptosis of lymphocyte cells in patients with HAM/TSP The presence of sFas, sFasL in the serum and cerebrospinal fluid (CSF) of patients with HAM/TSP was evaluated by using an enzyme linked immunosorbent assay (ELISA) The Fas, TNF ? and Bcl 2 protein expressions were quanlitatively determined by flow cytometry from 8 cases of HAM/TSP, and compared with the controls and other inflammatory neurological diseases (OIND) Results (1) The apoptotic ratio of lymphocyte cells in patients with HAM/TSP (13 63%?0 48%) was significantly increased as compared to the controls (1 63%?0 57%, P 0 05) Levels of sFas and sFasL in CSF from patients with HAM/TSP ((0 19?0 07) ng/ml and (0 24?0 08) ng/ml) were both significantly increased than those from OIND ((0 11?0 06) ng/ml and (0 01?0 01) ng/ml, P 0 05) or patients with OIND (34 84?9 63, P