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)

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)

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)

The association of crusted scabies with T-lymphotropic virus type I and adult T-cell leukaemia/lymphoma - abstract

Crusted scabies is a hyperinfestation with the mite Sarcoptes scabei var Hominis and is characterized by hyperkeratotic plaques and crusting, especially over bony prominences. The disease is often found in association with immunosuppression, down's syndrome, mental retardation and in patients with diminished sensation. Recently a significant association with human T-lymphotropic virus type I (HTLV-I) and adult T-cell leukaemia/lymphoma (ATL) has been reported. Over a 30-month period, 18 patients with crusted scabies were admitted to the dermatology ward, University Hospital of the West Indies, Mona. Of these patients, 13 (72 percent) were found to be HTLV-I seropositive and 4 of this group on further investigation were found to have ATL. The remainder of patients had other HTLV-I associated disease (tropical spastic paraparesis, infective dermattis with lymphocytic interstitial pneumonitis and psoriasiform eczema), immunosuppression due to a carcinoma and malnutrition associated with a cerebrovascular accident, lupus erythematosus on corticosteroid, and in 4 patients no underlying cause was found. Because of this strong association of crusted scabies with HTLV-I seropositivity and HTLV-I associated diseases in our environment, the determination of HTLV-I serostatus and investigation for possible ATL are mandatory in patients with this unusual form of scabies. (AU)