Disappearance of white matter lesions on MRI and clinical recovery after initiating antiretroviral therapy in a case of HIV infection presenting as spastic paraparesis.

We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection. Antiretroviral treatment was initiated leading, together with rehabilitation, to a progressive improvement of symptoms. Pathological lesions on brain MRI completely disappeared. In conclusion, HIV test should be done in every patient with neurological signs of unknown cause.

HTLV-1 infection and the viral etiology of multiple sclerosis.

The HTLV-1 virus produces a progressive inflammatory, and then degenerative, myelopathy which evolves progressively from onset. HTLV-1 in endemic in populations which are recognized as having low risk of multiple sclerosis . Multiple sclerosis generally evolves as a relapsing-remitting disease and affects predominantly Caucasians. In Caucasians, HAM/TSP can be marked by fluctuations as well as relapses. In Asians MS affects preferentially the spinal cord. The author hypothesizes that population selection through environmental factors has pushed the immune response of Caucasians towards generating relapsing-remitting disease and that of Primordial populations towards progressive disease. HTLV-1 endemicity being the marker of Primordial populations and its absence that of Caucasians.

Human herpesvirus-7 infection of the CNS with acute myelitis in an adult bone marrow recipient.

The beta-herpesviruses, human herpesviruses-6 and -7 (HHV-6 and HHV-7), are closely related and have very similar biological behaviour. While HHV-6 is associated with encephalitis in immunosuppressed adults, HHV-7 is not recognised as a cause of neurological disease in such patients. This report describes the identification of a reactivated HHV-7 infection in the cerebrospinal fluid of an adult who presented with an acute myelitis 11 months after unrelated donor bone marrow transplant.

Método de reação em cadeia por polimerase para a pesquisa de retrovírus em casos de linfomas não-Hodgkin de células T periféricas e paraparesias crurais espásticas / PCR methods for retrovirus search in cases of non-Hodgkin lynphoma of peripheral T-cells and crural spastic paraparesis

Partindo de dois oligonucleotídeos degenerados derivados de uma fração conservada da região pol de retrovírus conhecidos, foi pesquisada a presença de agente viral exógeno ou de uma seqüência endógena similar as retrovirais (ERV). A partir da amplificação do DNA pela técnica de PCR, foram testadas células mononucleares periféricas de 33 portadores de paraparesia crural espática de evolução crônica sem agente etiológico conhecido, produzindo um fragmento de aproximadamente 500 bp em 8 destas amostras...

Age-dependent neurologic manifestations of HIV infection in childhood.

Although the neurologic complications of HIV- 1 infection during the first two years of life have been defined, the neurologic features in older children are not so well described. The present report is focused on the age-dependent neurologic presentation of HIV-1 infection. Sixty-two vertically HIV-1 infected children underwent detailed serial evaluations: neurologic assessment, neuropsychological tests, neuroimaging studies, and cerebrospinal fluid analysis. Neurologic involvement was found in 30 patients (48.3%). This population was divided into two groups, exhibiting progressive (83.3%) or nonprogressive (16.6%) neurologic signs and symptoms. In the first group of patients, progressive encephalopathy was distinguished from spastic paraparesis, possibly due to spinal cord involvement. The second group, represented by long-term survivors, requires clinical monitoring due to the possible prognostic value of acquired but presently nonprogressive signs of brain involvement. In contrast with the stereotyped features of the early form of progressive encephalopathy, the late form showed a polymorphic picture, with age-dependent neurologic manifestations. Multifocal white matter alterations and cerebral calcifications (sometimes with delayed onset and progression) were the prominent imaging findings. A correlation between cerebrospinal fluid HIV RNA levels, suggestive of viral replication within the central nervous system, and progressive neurological disease were also found.

[Prevalence of HTLV-1 virus infection in Togo (Kozah prefecture and the University Hospital Center of Lomé]. / Prévalence de l'infection par le virus HTLV-1 au Togo (préfecture de la Kozah et CHU de Lomé).

The aim of this study was to determine the prevalence of Human T cell Leukaemia Virus Type 1 (HTLV1) in a representative population sample, in neurological and non-neurological patients hospitalised in the Lomé teaching hospital in order to study the clinical manifestations of this retrovirus. There was no statistical difference among the three groups concerning the prevalence of HTLV1 respectively (1.2%: 21/1717, 1.8%: 15/828 and 1.6%: 4/244). Spastic paraparesis was the only disease significantly linked to HTLV1 (15.5%: 9/58).

[HTLV-I tax gene on the etiological identification of tropical spastic paraparesis. A clinical, serological and polymerase chain reaction (PCR) study in 72 patients]. / El gen tax del virus linfotrópico humano tipo i en la identificación etiológica de la paraparesia espástica tropical: estudio clínico, serológico y de polimerasa en cadena en 72 pacientes.

BACKGROUND: Tropical spastic paraparesis (TSP) is an endemic disease in Chile. In most countries, only 50% of patients are seropositive to HTLV-I. However, new studies suggest that seronegative TSP is also associated with HTLV-I. AIM: To describe clinical and virological features of seronegative patients with TSP. PATIENTS AND METHODS: Seventy two Chilean patients with TSP, studied by clinical, radiological and laboratory methods during 1998, are reported. The determination of antibodies to HTLV-I was accomplished by ELISA, immunofluorescence and Western-blot analysis. Polymerase chain reaction for tax and 5'Ltr genes was made using primers SK 43-44, LTR1 and LTR6. RESULTS: Thirty one patients were HTLV-I positive and 41 were negative. No clinical, radiological or laboratory differences were observed between both groups. In seropositive patients, tax and 5'ltr viral gene sequences of the HTLV-I provirus were detected in DNA of peripheral blood mononuclear cells. In seronegative cases, sequences of tax gene were detected, exclusively, in 18 of 41 patients. CONCLUSIONS: These results confirm an association with HTLV-I infection in 43.9% of the TSP seronegative patients. These findings support the hypothesis that a defective provirus infects peripheral blood mononuclear cells in seronegative cases of TSP. The importance tax gene in the diagnosis of the TSP is also emphasized.