RESUMEN
Tropical spastic paraparesis/ HTLV-I-associated myelopathy (TSP/HAM) is the classical neurological manifestation of HTLV-I. Only a few studies have described isolated peripheral neuropathy (PN) among HTLV-I infected individuals. 335 infected individuals without TSP/HAM were evaluated for the presence of PN and 45 of them showed evidences of peripheral nervous system involvement. Of these 21 patients had isolated PN, defined by clinical and/or electrophysiological criteria. Sural nerve biopsies revealed inflammatory infiltrates in 2, axonal degeneration in 2 and segmental demyelination in 1. Therefore, peripheral neuropathy can be found as an isolated manifestation of HTLV-I infection. We conclude that HTLV-I infection should be investigated in patients with PN of unknown origin.
Asunto(s)
Infecciones por HTLV-I/complicaciones , Virus Linfotrópico T Tipo 1 Humano/inmunología , Paraparesia Espástica Tropical/diagnóstico , Nervios Periféricos/patología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Adulto , Anciano , Biopsia , Enfermedades Desmielinizantes/patología , Enfermedades Desmielinizantes/fisiopatología , Diagnóstico Diferencial , Electrodiagnóstico , Femenino , Infecciones por HTLV-I/inmunología , Infecciones por HTLV-I/fisiopatología , Humanos , Inflamación/patología , Inflamación/fisiopatología , Masculino , Persona de Mediana Edad , Nervios Periféricos/fisiopatología , Enfermedades del Sistema Nervioso Periférico/inmunología , Enfermedades del Sistema Nervioso Periférico/virología , Pruebas Serológicas , Nervio Sural/patología , Nervio Sural/fisiopatología , Degeneración Walleriana/patología , Degeneración Walleriana/fisiopatologíaRESUMEN
The human T-cell lymphotropic virus type 1 (HTLV-I) causes a neurological disease known as HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a minority of infected individuals. Although other neurological outcomes have been described their prevalence is presently unknown. To evaluate the frequency and characteristics of neurological involvement in a population of HTLV-I-infected blood donors we investigated 196 HTLV-I positive and 196 negative blood donors from a blood center of Rio de Janeiro, Brazil. Individuals with abnormalities at the neurological examination were examined by three neurologists, and when pertinent, additional neurological investigations were performed. Descriptive analysis, Student's t-test and chi2 test were employed for statistical analysis. Neurological abnormalities were found in 71 (36.2%) of the HTLV-I positive blood donors and in only 29 (14.8%) of the HTLV-I negative donors (OR = 2.54, 95% CI = 1.67-3.59, p = 0.000002). Cases of myelopathy, motor neuron disease and myopathy were only found in the HTLV-I positive group. In addition, peripheral neuropathy (PN) was significantly more frequent in the positive group (p = 0.015). In summary, our data suggest that HTLV-I-infected individuals exhibit a wide variety of neurological manifestations apart from the classical picture of HAM/TSP.
