Early Juvenile Human T-cell Lymphotropic Virus Type-1-Associated Myelopathy/Tropical Spastic Paraparesis: Study of 25 Patients

• Published in: Clinical infectious diseases Vol. 67; no. 9; pp. 1427 - 1433
• Main Authors: Varandas, Cinthya Maria Neves, da Silva, José Lucas Sena, Primo, Janeusa Rita L, de Oliveira, Maria de Fátima S P, Moreno-Carvalho, Otávio, Farre, Lourdes, Bittencourt, Achiléa L
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15.10.2018
• Subjects: infective dermatitis; vertical transmission; HAM/TSP; HTLV-1; HTLV-1 clustering
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy289

Frequent onset before 10 years of age Marked female predominance Related to vertical transmission of HTLV-1 Very frequent association with IDH Presence of rapid progressive courses Occurrence of infected cells in the CSF Abstract Background Human T-cell lymphotropic virus type-1 (HTLV-1) may cause severe diseases such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). The clinical characteristics and progression of 25 early onset HAM/TSP associated or not to IDH were described. Methods Following-up 37 IDH patients with neurological examinations, 54% developed HAM/TSP. To these cases were added 5 cases of juvenile HAM/TSP. The patients were HTLV-1+ and were submitted to dermatological and neurological examinations. Diagnosis of HAM/TSP was performed according to Osame et al (1990) and Castro-Costa et al (2006) criteria. Results Twenty-one patients were classified as definite HAM/TSP by both criteria, 3 as probable HAM/TSP by Osame et al, and another as probable HAM/TSP according to Castro-Costa et al Median age at onset of neurological manifestations was 9 years for the IDH/HAM/TSP group and 16 years for the HAM/TSP group (P = .045). In 12 patients, the onset of neurological manifestations occurred when they were less than 10 years of age. In the group IDH/HAM/TSP, the neurological symptoms always begun during the period of activity of IDH. The progression of HAM/TSP evaluated in 17 cases was heterogeneous, and 3 had rapid progressive course. Conclusions The juvenile HAM/TSP may occur very early and also presents marked female predominance. Progression of IDH to HAM/TSP before 19 years of age is frequent (54%). Rapid progressive form may also occur in early HAM/TSP. As juvenile IDH and HAM/TSP are due to vertical transmission through breastfeeding, it is very important to avoid this pathway of infection.