Neurological manifestations in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis in the Amazon

Dias, G A S; Yoshikawa, Gilberto Toshimitsu; Koyama, Roberta Vilela Lopes; Fujihara, Satomi; Martins, Leandra; Medeiros, Rita; Quaresma, Juarez Antônio Simões; Fuzii, Hellen Thaís

doi:10.1038/sc.2015.112

Cited by 14 publications

(15 citation statements)

References 23 publications

(29 reference statements)

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“…The prevalence of falls ranges between 39-49% among those aged >60 years old 10 , and it has been reported in two-thirds of HAM/TSP patients 7 . These findings reinforce the idea that HAM/TSP patients have an increased risk of falls and, consequently, of fractures 11 , 12 . Gait impairment is a major risk factor associated with falls; the reduction in the functional angle of the hip, knee, and ankle leads to compensatory axial movements and, ultimately, the need for mobility aids 13 .…”

Section: Discussionsupporting

confidence: 88%

Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis

Julca-Copello

Schwalb

Cachay

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: In patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) gait disturbance is a predominant feature that leads to falls and fractures, which can further aggravate disability. We sought to evaluate the impact of fractures and orthopedic surgeries in patients with HAM/TSP. Methods: We retrieved the medical records of HAM/TSP patients enrolled in our study center's HTLV-1 clinical cohort between 1989-2018. The selection criteria included: (1) diagnosis of HTLV-1 infection using two enzyme-linked immunosorbent assays and/or a confirmatory test, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) fractures associated with HAM/TSP. Results: We identified 24 cases of fractures, 70% of which were females. The median age at the time of fracture was 60 years (IQR=24). Six cases reported fractures in patients under 45 years old. Ten patients (42%) had hip/coccyx fractures, seven (29%) were in the lower extremities, and four (17%) in the upper extremities. Half of these patients reported the use of wheelchairs. Five patients who had previously used canes required the use of wheelchairs after the reported fracture. Eight patients underwent corrective orthopedic surgery as a result of the fracture. Conclusions: For HAM/TSP patients, fractures are a complication that can exacerbate their severe impairment.

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Section: Discussionsupporting

confidence: 88%

Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis

Julca-Copello

Schwalb

Cachay

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…It was higher in an epidemiologically semi-closed quilombo than the average of four municipalities (1.5% vs. 0.1%, respectively) investigated [87,94]. Since the initial detection of HAM/TSP in patients from the Marajo Archipelago, in the North region of Brazil [83], HTLV-1-infected male and female patients with different signs of clinical severity of neurological disease have been described [20]. Although there have been continuous descriptions of persons with other diseases, including dermatological symptoms [120], no hematological disorders, so far, have been associated with HTLV-1 infection in the ARB.…”

Section: Epidemiological Data Of Htlv-1 and Htlv-2 In The Amazon Regimentioning

confidence: 99%

“…HTLV integrates the transcribed RNA as a DNA provirus into the cell nucleic acid [12][13][14][15][16], and this simple evolutionary procedure leads to the persistence of the virus and its maintenance in nature and has serious implications for the different clinical and epidemiological outcomes of the infection and diseases associated with the virus. The wide array of clinical outcomes shows the target complexity within the human host (including the CNS, blood, lungs, eyes, muscles, bladder and skin), and several medical specialties have to be involved in the care and treatment of infected and diseased persons [17][18][19][20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

The challenge of describing the epidemiology of HTLV in the Amazon region of Brazil

Ishak

Vallinoto

2020

Retrovirology

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HTLV-1 was the first described human retrovirus and was soon found to be associated with severe clinical diseases, including a devastating lymphoma/leukemia and other inflammatory diseases. Although HTLV-2 is not usually pathogenic, it is widely distributed among native Indian populations in Brazil, particularly in the Amazon region of the country. Presently, HTLV spreads mainly by the sexual route and from mother to child, and virus persistence is an active biological factor aiding its transmission. Recently, the use of illicit drugs has been shown to be an additional risk factor, showing the influence of new habits on the epidemiology of HTLV in the region. Despite the detection of the virus in several different populations in the Amazon region of Brazil for almost 30 years, the exact prevalence of HTLV-1/2 is not well defined. The original biases in sampling and the selection of epidemiologically unsuitable populations were commonly repeated in most prevalence studies, generating unreliable and conflicting figures that do not represent the actual prevalence of HTLV. The improvements in clinical and laboratory facilities have resulted in the description of several clinical manifestations that were previously unknown in the region. The extent of the spread of the virus must be defined in this region, which is the largest geographical area of the country. As prophylaxis advances toward the use of vaccines against HTLV-1, it is important to determine who is at risk of being infected and developing a disease to successfully implement preventive measures, particularly as proposals are made to eradicate the virus among humans.

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“…Isso ocorre pela fraqueza muscular associada ao aumento do tônus com as alterações funcionais, os quais aumentam o risco de queda e levam à utilização de um dispositivo para locomoção. 30 Nesse contexto, os grupamentos musculares mais afetados dizem respeito à cintura pélvica e de membros inferiores e também por hiperatividade do detrusor, ocasionando diminuição do equilíbrio dinâmico, aumento do gasto energético, padrão de marcha em tesoura com encurtamento desses músculos, comprometendo as fases da marcha e urgência miccional, noctúria dentre outros. 27,31 Isso pode ser associado com o achado acerca da correlação entre o grau de auxílio da marcha e alteração do controle vesical, pois quanto maior o comprometimento da doença maior serão estas alterações, restringindo os domínios classificados como funções do corpo e atividade e participação.…”

Section: Discussionunclassified

Relação Da Função Vesical E Marcha Em Indivíduos Com Vírus Linfotrópico De Células T Humana Tipo 1

Silva¹,

Rocha²,

Araújo³

et al. 2018

SaudPesq

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Correlacionar a disfunção da bexiga e a necessidade de assistência na marcha em indivíduos com vírus linfotrópico de células T humana tipo 1. Trata-se de um estudo analítico, observacional e transversal, realizado com 16 pacientes de ambos os sexos, diagnóstico de Paraparesia Espástica Tropical/Mielopatia Associada ao HTLV-1 (PET/MAH) definitivo, avaliados pela Escala Ponderada de Paraplegia Espástica (EPPE) e caracterizados quanto ao grau de auxílio na marcha por meio dos dispositivos utilizados durante a deambulação. Todos os achados foram codificados pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF); aqueles relacionados à função vesical se converteram para o componente funções do corpo e quanto ao auxílio da marcha para atividade e participação. Utilizaram-se os testes G (Aderência), Qui-quadrado e o de correlação de Spearman para análise estatística (p≤0,05). A maioria apresentou problema ligeiro para função vesical (b6202.1) e nenhuma dificuldade (d465.0) ou moderada (d465.2) para a necessidade de auxílio na marcha. Houve correlação (p=0,009) entre o auxílio na marcha e a função da bexiga. Assim, os códigos da CIF mostraram que quanto maior a dificuldade de locomoção maior é o problema na função da bexiga.

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Neurological manifestations in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis in the Amazon

Cited by 14 publications

References 23 publications

Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis

Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis

The challenge of describing the epidemiology of HTLV in the Amazon region of Brazil

Relação Da Função Vesical E Marcha Em Indivíduos Com Vírus Linfotrópico De Células T Humana Tipo 1

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