The World Health Organization recommends the use of Osame's criterion (1990) for the diagnosis of HTLV-I-associated myelopathy (HAM/TSP). In 2006, a group of neurologists developed a Brazilian criterion that can diagnose HAM/TSP from its onset. OBJECTIVE: It was to test the agreement between both criteria. METHODS: The study included evaluation of clinical and laboratory findings of 35 patients. The ELISA, Western blot and/or polymerase chain reaction was used to search for anti-HTLV-I antibodies. The analysis of agreement was based on the calculation of Kappa. RESULTS: Concordance of 100% (Kappa=1) occurred in cases of "defined" HAM/TSP, but not in patients with "probable" diagnosis. CONCLUSION: The Brazilian criteria was as effective as Osame's criteria for the diagnosis of "defined" HAM/TSP. However, both require more specific biological markers in cerebrospinal fluid for the laboratory diagnosis of probable cases.
Intrathecal synthesis of human T-lymphotropic virus type 1 (HTLV-1) antibodies
(Abs) represents conclusive evidence of a specific immune response in the
central nervous system of HTLV-1 associated myelopathy/tropical spastic
paraparesis (HAM/TSP) patients. Western blotting (WB) for HTLV Abs in serum is a
confirmatory test for HTLV-1 infection. The aim of this study was to standardise
the Western blot to demonstrate the intrathecal pattern of Abs against HTLV-1
proteins in HAM/TSP patients. Paired cerebrospinal fluid (CSF) and serum samples
were selected from 20 patients with definite HAM/TSP, 19 HTLV-1 seronegative
patients and two HTLV-1 patients without definite HAM/TSP. The presence of
reactive bands of greater intensity in the CSF compared to serum (or bands in
only the CSF) indicated the intrathecal synthesis of anti-HTLV-1 Abs. All
definite HAM/TSP patients presented with an intrathecal synthesis of anti-HTLV-1
Abs; these Abs were not detected in the control patients. The most frequent
intrathecal targets of anti-HTLV-1 Abs were GD21, rgp46-I and p24 and, to a
lesser extent, p19, p26, p28, p32, p36, p53 gp21 and gp46. The intrathecal
immune response against env (GD21 and rgp46-I) and
gag (p24) proteins represents the most important humoral
pattern in HAM/TSP. This response may be used as a diagnostic marker,
considering the frequent association of intrathecal anti-HTLV-1 Ab synthesis
with HAM/TSP and the pathogenesis of this neurological disease.
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