Clinical characteristics of patients in Peru with human T cell lymphotropic virus type 1-associated tropical spastic paraparesis.

BACKGROUND: Human T cell lymphotropic virus type 1 (HTLV-1) is associated with tropical spastic paraparesis (TSP). Peru is an area of endemicity for HTLV-1. METHODS: All patients with suspected cases of TSP referred to our institute (Institute of Tropical Medicine Alexander von Humboldt, Lima, Peru) from 1989 through 2002 were interviewed and tested for HTLV-1. All patients with positive results were evaluated by an expert physician. Disease progression was defined as "rapid" if the time between TSP onset and inability to walk unaided was <2 years. RESULTS: Among 165 patients enrolled, the symptoms and signs most frequently found were spasticity (in 97.5% of patients), hyperreflexia (95.4%), lower limb paresthesia (90.2%), pyramidal signs (82.6%), urinary complaints (82.0%), and lumbar pain (79.0%). Rapid progression was present in 21.5% of patients; mean age at TSP onset was higher among these patients than among slow progressors (P<.001). Severe spasticity, diminished vibratory sensation, and tremor were found more frequently among rapid progressors, compared with slow progressors. CONCLUSIONS: HTLV-1--associated TSP is frequently diagnosed in areas of HTLV-1-endemicity. A subgroup of patients experiences rapid disease progression.

[Endoscopic findings in HIV-infected patients with esophageal symptoms. Experience at the Cayetano Heredia National Hospital]. / Hallazgos endoscópicos en pacientes con infección por el virus de la inmunodeficiencia humana (vih) con síntomas esofágicos. Experiencia en el hospital nacional Cayetano Heredia.

UNLABELLED: This study was done in patients with HIV infection and upper digestive symptoms as odinophagia, dysphagia and/or retrosternal pain who attended the Cayetano Heredia National Hospital in Lima, Perú. Those included in the study had an upper endoscopy and a CD4 count. Also previous opportunistic infections were determined. Samples were taken from the oropharyngeal cavity and sent for direct exam and culture. During endoscopy, photos were taken from the upper, middle, and lower third of the esophagus and the esophageal compromise was classified. Biopsies and brushings samples were obtained and sent for direct exam, histopathology and culture. RESULTS: 751 patients with HIV infection attended the Cayetano Heredia National Hospital between May 1996 and June 1999, 83 were included due to esophageal symptoms. Male / Female ratio : 4/1, mean age : 30.95 +/- 9.87. Cultures positive for Candida: 84.30% of esophageal biopsies samples, 88% of esophageal brushings and 60.2% of oropharyngeal cavity. The C. albicans species was isolated in 95.7% of biopsies, 93% of brushings and 96% of oropharyngeal cavity. The most common endoscopic finding was white plaques (71%), endoscopic grade 3 (36.1%). The most frequent previous opportunistic infection was PCP pneumonia followed by TBC. The positive predictive value for white plaques in patients with dysphagia and odynophagia was 89.8%. CD4 count between 0 and 50 lymphocytes per mm(3) was seen in 70% of the cases. The mean of CD4 lymphocytes of these patients was lower (p< 0.01) when compared to the mean of patients in the control group with no symptoms. CONCLUSIONS: Candida albicans was the most common isolated pathogen in the esophagus in patients with HIV infection and with esophageal symptoms, a significant difference in CD4 count between these patients and the control group was determined. The positive predictive value for finding esophageal white plaques in patients dysphagia and odinophagia was high, and there was no difference between the average of CD4 count and the endoscopic grade of esophageal involvement.