HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis in Brazil: A Nationwide Survey

Abstract

To study the epidemiology of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Brazil, we conducted a nationwide survey between March 1994 and April 1995. Five centers from three regions of the country participated, enrolling 163 patients. Most patients came from the northeastern and southeastern regions (93.2%). Most enrollees were white women, 42.9% and 64.4%, respectively. The most common risk factors for infection included a history of venereal diseases (30.6%) and blood transfusion (21.6%). The median age at the beginning of the disease was 42 years. The main neurologic findings were spastic paraparesis, widespread brisk tendon jerks, bilateral Babinski's sign, and bladder dysfunction. Some interregional differences reached statistical significance. The ratio of females over males increased from south to north. In addition, in both southern and southeastern regions, whites prevailed, whereas in the northeast, mulattos predominated. This follows the normal distribution of the population in these regions. A significantly higher rate of venereal diseases was found in the southeast compared with the other regions studied. A history of intravenous drug use was more frequent among patients as the sample moves south. Finally, a fluctuating course of the disease was proportionally more frequent in the southern region.

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP)

“…When the sample was analyzed according to the duration of the disease, from the group Seven subjects used more than one type of walking aids with less than 10 years of disease (n ¼ 31), 10% were restricted to wheelchair, and from the group with more than 10 years of disease (n ¼ 41), 22% were wheelchair bound. These data are similar to those of Nakagawa et al, 20 Araujo et al 21 and Cartier et al 22 The presence of muscle contractures complies with the gait pattern, the adductors being the most frequent involved muscles (83%). There were a minority of subjects with abnormal sensory examination (14%), in whom a distal deficit prevailed.…”

“…7,8 Patients were predominantly women (2:1) with an average age at onset of 40 years. Some subjects found it difficult to determine precisely the age at the onset of their disease, mostly because of the long period of the disease and the subtle and progressive installation of the initial symptoms.…”

“…The neurological examination generally shows weakness and spasticity in the lower limbs with an adductor pattern. 7,8 Because of its high prevalence in Brazil, there has been an increasing demand for rehabilitation treatment of individuals with HAM/TSP in the last years. This study aims at establishing the major characteristics of disability in subjects with HAM/TSP and to identify variables related to community ambulation.…”

HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection?

“…The first Brazilian nationwide study on the disease concluded that (1) HAM/TsP was more prevalent among women and whites, (2) the most important risk factors for infection were sexual promiscuity and blood transfusion, and (3) although a remarkably uniform disease throughout the country is observed, some statistically significant differences were detected such as a higher proportion of females over males in the Northeast region, a higher proportion of whites in the southeast and in the south while in the Northeast infection predominates in the mulattos, and a high rate of venereal diseases in the southeast region and of intravenous drug use in the south 29 .…”

Lack of tax diversity for tropical spastic paraparesis/human T-cell lymphotropic virus type 1 (HTLV-I) associated myelopathy development in HTLV-I-infected subjects in São Paulo, Brazil

“…Brazil is considered to be an endemic area for HTLV-I, with infections ranging from 0.5% in the South to 1.5% in the Northeast (Segurado et al 1997, Galvão-Castro et al 1997. HTLV-I-associated illnesses, such as TSP/HAM and ATL, have been described in different areas of the country (Castro et al 1989, de Oliveira et al 1990, Araujo et al 1998.…”