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

Abstract

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.

HTLV-1 proviral load in infective dermatitis associated with HTLV-1 does not increase after the development of HTLV-1-associated myelopathy/tropical spastic paraparesis and does not decrease after IDH remission

“…For each patient, it was possible to compare PVL before and after HAM/TSP development (intra-individually, paired samples) and they were similar, no significant differences were observed (p = 0.3650, Wilcoxon matched-pairs signed rank test) (Fig 2A). It is important to note that IDH preceded HAM/TSP manifestation in all IDH/HAM/TSP patients [2].…”

“…At each visit, neurological and dermatological examinations were performed including measurement of Osame Motor Disability Score (OMDS) [9] and Expanded Disability Status Score (EDSS) [10] and the participants were submitted to routine laboratorial exams. Dermatological aspects of these patients were previously described [6], while neurological aspects of HAM/TSP patients were recently reported [2]. IDH patients with active disease were treated with systemic sulfamethoxazole-trimethoprim.…”

“…As HTLV-1 infection in these children and adolescents occurred vertically, by breastfeeding [2,6], we tested whether the levels of PVL correlated with age. PVL did not correlate with age when considering all individuals included independently of clinical conditions (p = 0.2725, r = -0.1733, Spearman's rank correlation) or within disease groups.…”

“…IDH is a chronic and severe form of exudative and infective childhood dermatitis. HAM/TSP is a chronic myelopathy characterized by slow progressing spastic paraparesis and ATL is an aggressive, mature T-cell malignancy characterized by a poor response to chemotherapy [1][2][3].…”

“…Around 47% of the IDH patients in Bahia, Brazil develop HAM/TSP even in adolescence [2]. Juvenile HAM/TSP is clinically similar to adult HAM/TSP but is mainly associated with vertical HTLV-1 transmission and can present rapid progression [2]. The factors predisposing to juvenile HAM/TSP in IDH patients were not yet established.…”