Clinical, pathologic, and immunologic features of human T-lymphotropic virus type I- associated infective dermatitis in children

Objectives: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotropic virus type 1 (HTLV-I). Design: A case series of patients with ID were compared with patients with atopic dermatitis (AD) which is an important disease in the differential diagnosis of ID. Setting: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. Main Outcome Measures: Clinical and laboratory features of patients with AD were compared with those of patients with ID. Patients: Consecutive patients older than 1« years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. Results: The mean age of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both disease were predominantly chronic dermatitis... Conclusion: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.(AU)

Childhood dermatitis in the tropics: with special emphasis on infective dermatitis, a marker for infection with human T-cell leukemia virus-I

Eczema in the tropics is a common problem. Although it is a major cause of discomfort among children worldwide, a warm tropical climate often has important repercussions for children with dermatitis. The original description by Sweet empahasized that interest in tropical eczemas extended to the English, as children of West Indian immigrants in England were affected. Likewise, immigrants may carry these disorders with them to the United States. In Jamaica, a tropical country, the largest and most populous of the English-speaking Caribbena islands, eczema is by far the most common skin disorder seen in children attending dermatology clinics. Reports from other Caribbean islands suggest that this is true for the region as a whole. In 1981, Alabi and La Grenade reported that from 1971 to 1975 eczema accounted for 46.7 percent of skin rashes seen in children at the University Hospital of the West Indies. Review of the period 1988 to 1993 showed that 52 percent of the 601 children who attended the skin clinic for the first time had eczema, confirming the earlier finding. In this latter review, atopic eczema was the most common type of eczema (52 percent), followed by seborrheic eczema (20 percent) and infective dermatitis (10 percent). The remaining 18 percent had a variety of unclassified eczemas including pityriasis alba, discoid eczema, acute vesicular eczema of the hands and/or feet, and hyperkeratotic eczema of the feet.(AU)

Human T-cell lymphotropic virus type 1 infection in Barbados: results of a 20-year follow-up study

Forty-one human T-cell lymphotropic virus I (HTLV-1)-seropositive individuals were identified among 1,012 subjects with stored serum samples from a health and seroepidemiological survey conducted in Barbados in 1972. These 41 subjects plus 79 HTLV-1 seronegative household members were targeted in a follow-up study 20 years later. Sixteen seropositive subjects and 22 seronegative subjects were interviewed, examined, and phlebotomized. There were no changes in HTLV-1 serostatus between the 1972 and follow-up serum samples. Three (19 percent) of the seropositive subjects had HTLV-1 serostatus between the 1972 and follow-up serum samples. Three (19 percent) of the seropositive subjects had HTLV-1-associated disorders: two with dermatitis and one with <

The epidemiology of HTLV-1 and risk of disease and outcome: Jamaica

HTLV-1 is a human retrovirus endemic in the Caribbean and Japan. The crude prevalence in Jamaica is 5-6 per cent but there is a steady increase with age peaking in the 8th decade at 17 per cent among females and 9 per cent among males. The majority of persons infected with HTLV-1 do not manifest any clinical disease. However, some persons develop adult T-cell lymphoma, tropical spastic paraparesis or infective dermatitis. Associations with arthropathy, uveitis, polymyositis and panbronchiolitis have also been reported. HTLV-1 is transmitted via sexual contact, mother to child (mainly through breast milk) and by transfusion of cellular blood product. Male to female sexual transmission is far more efficient than female to male. Control of HTLV-1 requires screening blood transfusions and reducing sexual and vertical transmission. (AU)

HLA DRBI *DQB1* haplotype in HTLV-I-associated familial infective dermatitis may predict development of HTLV-I-associated myelopathy/tropical spastic paraparesis

A possible causal association between infective dematitis and HTLV-I infection was reported familial infective dematitis (ID) occurring in a 26-year-old mother and her 9-year-old son. The mother was first diagnosed with ID in 1969 at the age of 2 years in the Dermatology Unit at the University Hospital of the West indies (U.H.W.I.) in Jamaica. The elder of her 2 sons was diagnosed with ID at the age of 3 years, also at U.H.W.I. Both mother and son are HTLV-I-seropositive. A second, younger son, currently age 2 years, is also HTLV-I-seropositive, but without clinical evidence of ID. Major hitocompatibility complex (MHC), class II, human leucocyte antigen (HLA) genotyping documented a shared class II haplotype, DRB*DQBI* (1101-0301), in the mother and her 2 sons. This same haplotype has been described among Japanese patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and has been associated with a possible pathologically heightened immune repsonse to HTLV-I infection. The presence of this haplotype in these familial ID cases with clinical signs of HAM/TSP may have contributed to their risk for development of HAM/TSP. The unaffected, HTLV-I seropositive younger son requires close clinical follow-up. (AU)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)

Tropical spastic paraparesis ocurring in HLTV-1 associated infective dermatitis: report of two cases

An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection(AU)

HTLV-I, infective dermatitis, and tropical spastic paraparesis

Since human T-cell lymphotropic virus (HTLV-I) was identified in 1980 as causing human disease, it has been etiologically associated with adult T-cell lymphoma/leukemia (ATL) and tropical spastic paraparesis (TSP). More recently, several new diseases have been reported in association with this virus, including infective dermatitis of Jamaican children, which we reported in 1990. Studies on infective dermatitis have shown that these children have abnormalities of immune function, and some develop other HTLV-I associated disorders, including TSP. This paper reviews the work done on infective dermatitis to date, and explores the association with TSP (AU)

Immunological abnormalities in HTLV-1 infected Jamaican children (abstract)

This paper reports on the immunological findings of a case control study of 50 infective dermatitis (ID) patients and 36 atopic eczema (AE) patients undertaken between December 1990 and August 1991. It also reports on a comparison of these results with those of age and sex matched normal controls, and age and sex matched HTLV-I infected asymptomatic children. Investigations of their immune systems showed that both ID and AE patients had normal responses to delayed hypersensitivity skin tests, and normal compliment levels. However there was a marked increase in the activity of both T and B lymphocyte systems, with all immunoglobulin levels being significantly increased in ID patients versus others. The CD4:CD8 ratio was increased, with an increase in the CD4 counts. Monoclonal antibody tests showed increased T cell activation. The results confirm immune dysfunction though the precise mechanism of the immunodysregulation remains to be determined. (AU)

The evolving natural history of infective dermatitis in Jamaica - abstract

Infective dermatitis (ID) of Jamaican children, described in 1966, has recently been shown to be associated with human T-lymphotropic virus type 1 (HTLV-1) infection. This retrospective study of patients with infective dermatitis attending the dermatology clinic since 1970 was undertaken to determine trends in the natural history of the disorder and to define any link with other established HTLV-I associated disorders such as adult T-cell leukaemia/lymphoma (ATL) and tropical spastic paraparesis (TSP). Eighty-one patients have been followed. The results indicate that scabies was the commonest associated disorder seen in 15 patients (18 percent), with crusted scabies in 2 of these patients. Corneal opacities were seen in 8 patients (10 percent). Tropical spastic paraparesis was seen in 3 patients;lymphocytic interstitial pneumonitis was seen in 2 patients both of whom were persistently negative for human immunodeficiency virus (HIV) antibodies. Chronic glomerulonephritis was seen in 2 patients which led to chronic renal failure and death in one of these. Three patients with infective dermaitis died, one of definite ATL and two of ATL-like syndromes. These results indicate that at least a proportion of patients with infective dermatitis are at risk of developing other HTLV-I associated disorders, as well as other disorders of the immune system. These patients therefore require careful long-term follow-up (AU)

Immunological studies in infective dermatitis flow cytometric analysis of lymphocyte subpopulations in 41 cases - abstract

Infective dermatitis (ID) is a newly described HTLV-I associated with chronic dermatitis that is characterized by super infection of the skin with non-virulent pathogens. In order to investigate the possible mechanisms for this associated immune dysfunction we examined, by flow cytometry, lymphocyte subpopulations in a study group of 41 patients with infective dermatitis and compared the results with an age and sex matched group of patients with atopic eczema (AE) not associated with HTLV-I. Our results show an increase in total T-cells (CD3/Leu 4 +)2 T-helper inducer cells (CD4/Leu 3+), Activated T-cells (Leu RLA - DR+) and a subpopulation of cytotoxic T-cells (CD57: CD8/Leu 7+: Leu 2+) in the study group over the controls. The results support previous observations that T-cell aberrations in asymptomatic HTLV-I seropositive individuals, patients with Tropical Spastic Paraparesis (TSP) and adult T-cell leukaemia (ATL). It would appear that HTLV-I-induced immunodeficiency may be the result of phenotypic qualitative defects in T-lymphocyte subpopulations although absolute counts may be elevated (AU)

Infective dermatitis of Jamaican children 1966-1991 - abstract

Infective dermatitis of Jamaican children, first described by Sweet in 1966, is a chronic eczema associated with persistent infection of the skin or anterior nares with either staphylococcus aureus or B haemolytic streptococcus, or both. In 1990, we reported a pilot study of 14 children with infective dermatitis (ID) and 11 with atopic eczema (AE) as controls, which showed that all the ID patients were positive for antibodies to the human T-lymhotrophic virus (HTLV-1). We postulated then that there was an association between HTLV-1 infection and infective dermatitis, and suggested that this organism might be causing ID through an immune mechanism. This paper reports on findings of a case control study of 50 ID patients and 36 AE patients undertaken between December, 1990 and August, 1991, which confirms the association between HTLV-I and infective dermatitis. All 50 patients with ID were positive for HTLV-I and antibodies, while the AC controls were all negative. In addition, when compared to the atopic controls, the ID patients had lower haemoglobins, higher white cell counts, and higher ESRs. They also had lower serum albumins and serum irons. Investigations of their immune systems showed that both groups had normal responses to delayed hypersensitivity skin tests, and normal complement levels. However, there was a marked increase in the activity of both T and B-lymphocyte systems, with all immunoglobulin levels being significantly increased in ID patients. The CD4: CD 8 ratio was increased, with an increase in the CD4 counts. Monoclonal antibody tests showed increased T-cell activation. The results confirm the association between HTLV-1 infection and infective dermatitis and confirm immune dysfunction. The precise mechanism of the immunodysregulation, however, remains to be determined (AU)

Infective dermatitis of Jamaican children: a marker for HTLV-I infection

In Jamaican children infective dermatitis is chronic eczema associated with refractory nonvirulent Staphylococcus aureus or beta haemolytic streptococcus infection of the skin and nasal vestibule. 14 children between the ages of 2 and 17 years with typical infective dermatitis, attending the dermatology clinic at the University Hospital of the West Indies in Jamaica, were tested for antibody to human T-Lymphotropic virus type 1 (HTLV-1). All were seropositive, whereas 11 children of similar age with atopic eczema were all negative. In 2 of 2 cases of infective dermatitis, the biological mother was HTLV-1 seropositive. None of the 14 patients showed signs of adult T-cell leukaemia/lymphoma, though experience with previous cases of infective dermatitis indicates the possibility of such progression. (AU)

Contact dermatitis: or detective dermatology - abstract

The technique of patch testing is the recognised method of confirming a suspected diagnosis of allergic contact dermatitis. Routinely, a number of tests are applied at the same time - the so-called standard battery. This paper reports on the introduction of standard battery patch testing on 103 consecutive patients tested between March 1986 and December 1987 at the Dermatology Unit of the University Hospital of the West Indies. The North American Standard battery series was used. Forty percent of the 104 patients had positive tests. The commonest allergens were formaldehyde, 7; p-tert-butylphenol formaldehyde resin, 7 (PTBP is an adhesive used mainly in the shoe manufacturing process); nickel, 6; lanolin, 5 (wool fat used as a base for emollient creams and cosmetics), and thuiran, 4 (rubber chemical). The commonest referral diagnosis were eczema of the hands and feet (31/103) either singly or in combination, chronic leg ulcers with surrounding eczema or delayed healing (23/103), and atopic eczema presenting with unusal features (11/103). The highest number of positive tests was found in patients with the diagnosis of eczema of the feet (10/14); 7 of the 10 were allergic to PTBP, the adhesive in their shoes. These results confirm that patch testing is a useful and cost-effective diagnostic tool. Further battery patch testing should be done in Jamaica, as well as in other West Indian islands, with a view to establishing our own standard battery to replace the American one currently being used (AU)

Incidence of skin disease in rural Jamaica

The incidence of skin disease in people seeking health care in rural Jamaica during the period January to December 1985 has been studied. Results indicate that of 14,179 clinic visits reviewed, 6 percent involved a primary dermatological diagnosis. Infectious and parasitic diseases predominated, with scabies, impetigo, and tinea being the most common diagnoses. Of these, scabies accounted for nearly one third of all dermatologic visits. Noninfectious skin disease accounted for less than 10 percent of dermatologic diagnosis, with unclassified eczema making up the majority. Undiagnosed skin conditions contributed one third of dermatologic visits, with an incidence inversely related to the incidence of scabies visits. This relationship suggests that many evaluations of skin conditions were based on the exclusion of scabies with no alternative diagnosis. (AU)

Gonococcaemia with arthritis, dermatitis and myocarditis

Six cases of gonococcaemia seen at the University Hospital of the West Indies are described. All presented with polyarthritis and all but one had skin lesions. They varied widely in severity and chronicity and included one case with rigors and myocarditis. Emphasis is placed on the diagnostic value of the scanty skin lesions, and the importance of repeated examination of cervical swabs (Summary)