Sibling adult T-cell leukemia/lymphoma and clustering of human T-Cell lymphotropic virus type I infection in a Jamaican family

BACKGROUND:- Human T-cell lymphotropic virus type I (HTLV-I) infection is endemic in Jamaica, with an estimated crude seroprevalence of 5percent. Adult T-cell lymphoma/Leukemia (ATL), a disease caused by HTLV-I, has an incidence of 1-2/100,000 in the Jamiacan population. Familial ATL has not previously been reported from Jamaica. METHODS:- Hospital records and histologic specimens of the two cases were reviewed. HTLV-I infection was confirmed by antibody testing and by polymerase chain reaction on paraffin-embedded tissue,where serum was unavailable. Family members identified by the patient's parents. After giving informed consent, family members were asked to complete an interviewer-administered questionnaire and to agree to phlebotomy. RESULTS:- ATL developed 10 years apart in two siblings from a Jamaican family at age 16 and 24 years. A study of 19 members of their extended family, including both parents, 2 grandparents, and 3 siblings, revealed an overall HTLV-I seroprevalence of 17 percent. This compared with 75 percent among parents and sibling living in the same household as the patients (AU)

Biochemical abnormalities in multiple myeloma

Monoclonial gammopathies can either be benign or more commonly malignant. The commonest disease associated with it is multiple myeloma. Over the seven-year period 1984-1990, two hundred and thirty-four monoclonal gammopathies were seen at the University Hospital, Jamaica. Multiple myeloma was diagnosed in one hundred and fifty-six cases (84 males and 72 females). The diagnosis of most of the others were not known as the samples came from other institution. Of the patients with myeloma, the most common immunoglobulin type was IgG followed by IgA and then pure light chain disease. Only in about half of the cases where urine was analysed was Bence-Jones protien found. The majority of the cases had abnormal total serum protein, albumin and total globulin concentrations. Most of the cases also were in renal failure. Hypercalcaemia, hyperphoshataemia, elevated alkaline phosphate, gammaglutamyl transferase and aspartate aminotransferase occured in about one-third of them. These results were not much different from those reported in other countries. (AU)

Ants: potential mechanical vectors of bacterial pathogens at two hospitals in Trinidad - abstract

Following reports of ants infestation at the Neonatal Unit, Mount Hope Women's Hospital (MHWH), ants were systematically collected under sterile conditions from the laundry and kitchen areas and Neonatal Units of the MHWH and the General Hospital, Port-of-Spain (P0SPGH), Trinidad. Four species of ants were identified: Monomorium pharoensis, "sugar" ant, Tapinoma sessile, odorous house ant, Solenopsis sp. and Solenopsis molestus, "thief" ant. Bacterial contamination of ants was investigated by allowing ants to walk on surfaces of standard culture media and by inoculating media with a mixture of crushed ants in trypticase soy broth. Eight bacterial species, 6 of which are known human pathogens were isolated: Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas sp., Staphylococcus sp. and Streptococcus sp. from the MHWH, and Enterobacter sp. from the POSGH. Pathogens isolated from ants were thse same as those isolated from neonates during an outbreak of nosocomial infection at the Neonatal Unit, MHWH. This study, the first reported in the Caribbean, confirms that ants species can be mechanical vectors of human pathogens (AU)

Parasitic infections in young Jamaicans in different ecological zones of the island

Data are presented for the first country wide prospective study on gastrointestinal tract parasitic infections done in Jamaca. Samples from 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island were analyzed. Pica was practised by 8.6 percent. Generally, prevalence of organisms was as follows: Trichiuris trichiura (12.3 percent). Ascaris lumbricoides (9.5 percent), hookworm (2.2 percent), Strongyloides stercoralis (0.35), Giardia lamblia (6.3 percent) and Entamoeba coli (7.7 percent). Several other species of protozoans were recorded. Prevalence of A. lumbricoides, T. trichiura and Necator americanus was significantly greater in upland than in lowland (both rual and urban), while the situation was reversed for G. lamblia-infections. Greatest variations were age-related. A.lumbricoides and T. trichiura reached peak prevalence of 15-19 years of age. Suggestions are made for a national and even regional antihelminthic program for the mass treatment of pre- and primary school age children. (AU)

The immunophenotyping of non-hodgkin's lymphoma in formalin-fixed paraffin-embedded tissue - abstract

In this study, we have retrospectively determined the immunophenotype of forty-five cases of non-Hodgkin's lymphoma (HNL) diagnosed in the Department of Pathology at the University Hospital of the West Indies (UHWI) between 1984 and 1986. We used an immunoalkaline phosphatase technique with a panel of monoclonal antibodies reactive against T-cells (UCHL 1; MT 1), B cells (L 26; 4KB5; LN 2) and macrophages (Ber.H2). We found that this panel could accurately identify T-cell lymphomas and B cell lymphomas in formalin-fixed paraffin-embedded tissues. Of forty-five cases, twenty-six were of T-cell lineage and twelve were of B-cell lineage. Sixteen of the T-cell lymphomas were human T-cell leukemia-lymphoma virus type 1 (HTLV-1) positive and showed the additional clinical and pathological features of adult T-cell leukemia/lymphoma (ATL). The HTLV-1 negative cases were neither morphologically nor immunologically different from the HTLV-1 positive patients. None of the B cell lymphomas were HTLV-1 positive. The results lend further support to the finding that NHL in Jamaican patients is predominantly of T cell origin and associated with human T cell lymphotropic virus, type 1 (AU)

Haemoglobin reference values in the Jamaican population - abstract

In a study of the iron nutritional status of the Jamaican population, the reference range for haemoglobin (Hb) was determined. Mean Hb levels in all age groups were markedly lower than internationally accepted values (Table). The cut-off points used to define anaemia were also determined and they were also markedly lower than the international values. Use of the local cut-off points resulted in a lower prevalence of anaemia than if international values were used and in the identification of one third of individuals with iron deficiency (determined by iron stores measurement) as being anaemic. Local reference ranges for haemoglobin should be developed, wherever possible, as this study clearly shows that the internationally accepted ranges are not universally applicable (AU)

Sibling ATL and familial clustering of HTLV-1 infection in a Jamaican family - abstract

Two siblings from a Jamaican family developed adult T-cell leukaemia/lymphoma (ATL) in 1979 and 1989 respectively. The latter was HTLV-1 seropositive. Our aims were, to study the seroprevalence of HTLV-1 in the household of the index cases and among relatives living in the same parish, to identify any relative with HTLV-1 associated diseases (ATL and HAM/TSP) and the presence of risk factors for acquiring HTLV-1 infection. Eighteen (18) family members including two parents, 2 grandmothers, 3 siblings, 7 uncles and 4 aunts of the index cases were studied. The medical records of the first sibling were reviewed. Both parents and 2 of the siblings' studies live in the same house as the index cases. Results of the enzyme-linked immunoabsorbent assay (ELISA) testing are shown on the pedigree. Four members of the index cases' household were antibody (Ab) positive, whereas no family member outside the household was Ab positive. The sero status of the first case of ATL is unknown as she died in 1979. HTLV-1 Ab positive and Ab negative subjects had a similar mean age 34 and 38 years respectively. Neither group reported sexual contact with prostitutes or male homosexual activity. Among 18 healthy family members, no significant lymphadenopathy or neurological abnormality was detected. The high rate of HTLV-1 seropositivity among the family in the affected household (3/4 - 75) and the family overall (3/18 = 17 per cent) of the index cases were significantly greater than the general population (5 per cent). These findings support the theory that transmission is likely to take place horizontally, by sexual contact (husband to wife) and vertically (mother to child). The persistent Ab seronegativity of the 12 year-old child in the affected household is noteworthy, and the presence of other markers of HTLV-1 infection is being investigated (AU)

Parasitic infections in young Jamaicans in different ecological Zones in the Island - abstract

A gastrointestinal tract parasitological study was done on 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island where pica was practised by 6.9 percent. Generally, the prevalence was Trichuris 12.3 percent, Ascaris 9.5 percent, Hookworm 2.2 percent, Strongyloides 0.3 percent, Giardia 6.3 percent and E. coli 7.7 percent. Several other spp. of protozoans were recorded. Prevalence of Ascaris, Trichuris and Necator was significantly greater in upland than in lowland areas, both urban and rural, while the situation was reversed for Giardia infections. Greatest variations in prevalence were age-related. Ascaris and Trichuris reached peak prevalences of 15.3 percent and 20.5 percent, respectively, in 5-9 year olds, while Hookworm peaked later at 15-19 years of age. Suggestions are made for a national, even a regional, antihelminthic programme for the mass treatment of pre- and primary school age children. This would aim at the eventual eradication of helminthiasis in the region (AU)

An assessment of the iron status of the Jamaican population - abstract

Iron deficiency is believed to be responsible for the high prevalence of anaemia in Jamaica and the Caribbean. The groups reported to have the highest incidence of anaemia are pre-school children, pregnant and lactating females. All the data on the extent of anaemia have been based on haemoglobin measurements. This has been shown not to be an accurate estimate of body store of iron. This study was undertaken to determine the iron status of individuals under 19 years of age and of pregnant and lactating females in Jamaica. The haemoglobin, serum ferritin, transferrin saturation and free erythrocyte protoporphyrin of 2,544 people in all geographical areas and socio-economic classes, were measured and used to estimate the iron stores. The results show that approximately 50 percent of pregnant females and infants less than 2 years of age had low iron stores. There was also a high incidence of low iron stores in children between 2 and 5 years of age (approx 25 percent), and in lactating females (29 percent). Mean haemoglobin levels in all age and sex groups were lower than internationally accepted standards. In all age-sex groups, haemoglobin measurements overestimated the prevalence of iron deficiency. Although there was a good correlation between iron stores and haemoglobin levels, measurement of haemoglobin did not appear to be a good tool for screening for iron deficiency. These data indicate that iron deficiency is a major cause of anaemia in Jamaica and provide the basis for the evaluation of an iron supplementation programme, should one be embarked upon (AU)

Modelling the risk of adult T-Cell leukemia/lymphoma in persons infected with human T-lymphotropic virus type I

Adult T-cell leukemia/lymphoma (ATL), a malignancy of mature CD4-positive lymphocytes, has been etiologically linked to the human retrovirus HTLV-I. Although a long latent period is suggested from malignant studies, little prospective information on the risk of developing ATL among persons with HTLV-I infection is available. We present here a model of ATL risk based upon age- and sex-specific HTLV-I seroprevalence data from a cross-sectional survey of 13,000 Jamaicans and ATL incidence data from a 2« year case-control study. By examining the age-specific incidence of ATL relative to both adult and childhood-acquired seropositivity versus childhood-acquired seropositivity alone, we provide evidence in support of the hypothesis that childhood infection with HTLV-I is important to the development of ATL. Using this model, the cumulative lifetime risk of ATL for those infected before age 20 is estimated to be 4.0 percent for males and 4.2 percent for females. Under this hypothesis, HTLV-I-associated diseases with shorter latent periods, such as tropical spastic paraparesis, should have a higher incidence in adult females than in adult males. (AU)

Year-round total serum IgE and IgG4 levels in allergic and non-allergic West Indian medical students

Twenty-four allergic and non-allergic West Indian medical students and pathology technologists had repeated serum IgE an dIgG4 levels determined over a one-year period. Contrary to previously published reports on this type of population, total serum IgE levels were usually consistently normal (18 of 24 subjects) with little variation throughout the year. The remaining six subjects, all allergic and non-allergic elevated levels (620-1096 kU/1). Total serum IgG4 was elevated in most of the allergic and non-allergic subjects (18 0f 24). Perennial exposure to molds and house dust mite in this tropical environment could possibly produce the chronic antigenic stimulation reponsible for the elevation in serum IgG4 levels found in this study (AU)

A case control study of adult T-cell leukaemia/lymphoma and human T-lymphotropic virus type I in Jamaica - abstract

Ninety-three patients with haematological malignancies were enrolled into the study between Janauary, 1984 and August, 1985. Of these, 23 fulfilled the clinicopathological criteria for the diagnosis of adult T-cell leukaemia/lymphoma (ATL). Eighteen of 23 ATL patients were HTLV-I seropositive, compared with 8 of 46 age- and sex-matched general medical controls, resulting in a claculated odds ratio (estimated relative risk) of 17:1. Other patients with non-Hodgkin's lymphoma had slightly higher seropositivity rates than the controls, but none of the other haematological malignancies were HTLV-I positive. No other risk factors for ATL were conclusively demonstrated. The recently noted association of HTLV-I with tropical spastic paraparesis (Jamaican neuropathy) was supported by a high level of HTLV-I antibodies among patients with certain neurological disorders (AU)

Non-hodgkin lymphoma in Jamaica and its relation to adult T-cell leukemia-lymphoma [published erratum appears in Ann Intern Med 1987 Jun;106(6):917]

Of 95 patients consecutively diagnosed with non-hodgkin lymphoma, 52(55 percent) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positively was strongly associated with skin involvement, leukemia, and hypercalcemia (p<0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinnant of adult T-cell leukemia-lymphoma.(AU)

Immunology of non-hodgkin's lymphoma in Jamaica - abstract

This study was undertaken to determine the immunological profile of non-Hodgkin's lymphoma (NHL) patients in Jamaica. Immunoperoxidase (IP) and immunofluorescence (IF) techniques were used, employing a panel of monoclonal antibodies, to detect T and B lymphocytes and their subjects in lymph nodes and cell suspensions obtained from 22 patients diagnosed consecutively from January, 1985. Results of immunological typing were compared with results of HTLV-1 (Human T-cell lymphotropic virus type I) antibody testing, and with the histological pattern. Sixteen of the patients (73 percent) had T-cell disease and 4 had B-cell disease. Results were equivocal or unsatisfactory in 2 patients. Fourteen who had T-cell disease were further subtyped. Thirteen had the helper-inducer phenotype and 1 had the cytotoxic-suppressor phenotype. There was close agreement between the results of IP typing of lymph nodes and cell suspensions, and of IF typing of cell suspensions, 15 (12 T-cell and 3 B-cell) of the 20 patients tested showing identical results. Three patients who were typed as T-cell disease by the IP technique were typed as normal or immunosuppressed by the IF technique. However, the IP typing was done before, and the IF was done after, treatment. Discrepancies in the results for 2 patients are unexplained. Eight of the 14 patients with T-cell disease for whom results of HTLV-I antibody testing are available are HTLV-I antibody-positive. Both of the patients with B-cell disease for whom these results are available are antibody-negative. There was no correlation between lymphocyte phenotype and histological pattern (AU)

Skin manifestations of HTLV-associated adult T-cell lymphoma/leukaemia in Jamaica - abstract

A prospective study was conducted on 56 consecutive patients with the diagnosis of non-Hodgkins lymphoma (NHL) who presented between February 1982 and April 1984. The aims were to determine the frequency of skin involvement in patients with NHL and in particular those NHL patients who were also in HTLV-positive and satisfied the criteria for adult T-cell lymphoma-leukaemia (ATL) to characterise the types of skin lesions, to determine the relationship of skin involvements to course and prognosis and to determine whether any differences existed in the skin manifestations of HTLV positive and HTLV negative patients. Skin biopsies and skin scrapings for microscopy and culture were done where indicated, as well as HTLV antibody assays. Thirty-one patients (62 percent) were HTLV-positive, 16 males and 15 females. Their ages ranged from 20 to 63 with an average age of 41 years. Twenty (65 percent) had probable ATL and 7 (23 percent) possible ATL. Twelve of the 20 probable ATL had skin involvement. Fifty per cent (6/12) had skin lesions at initial presentation. The other 6 developed lesions during the course of their illness from 6 weeks to 1 year after diagnosis. The commonest type of skin lesion was generalized papulonodular in 50 percent of patients. Pruritus was present in 25 percent of patients. The median survival was 6 months in patients with skin involvement and 2 months in patients without - an insignificant difference statistically. Crusted scabies was found in 5/12 (42 percent) of the ATL patients and was recurrent in 3 patients. These results confirm that ATL is HTLV-associated, commonly presents with skin lesions, but is quite different from the two classical cutaneous lymphomas of the skin, mycosis fungoides and the Sezary's syndrome, in both morphology of the skin lesions and course and prognosis of the disease, the course of ATL being short and explosive with hypercalcaemia rather than skin lesions being the most important diagnostic factor (AU)

Infection in human T-cell lymphoma virus (HTLV)-positive and HLTV-negative lymphoma in Jamaica - abstract

Systematic opportunistic infections occur in approximately 20 percent of cases of HTLV-positive lymphoma seen in Japan and the South-Eastern United States. In a study conducted between February 1, 1982 and January 31, 1984, 38 cases of lymphoma diagnosed at the University Hospital, Jamaica, were reviewed to determine the types of infections that occurred in these patients. Sixteen of 23 (60 percent) and 11 of 15 (73 percent), HTLV-positive and HTLV-negative patients respectively developed one or more infectious episodes during their illness. In the HTLV-positive group, there were 36 such episodes, while 23 occurred in the negative group. Five each of HTLV-positive and negative patients had only one infectious episode while the remainder had 2 or more. The pattern of infections was similar in both groups with septicaemia, skin, buccal cavity, lung and urinary tract being the most common sites of infection. Severe infections accounted for 13 of the 36 (36 percent) infectious complications in the HTLV-positive patients and in 8 of the 23 (35 percent) episodes in the HTLV-negative group. Six of 36 (17 percent) and 13 of 23 (56 percent) infectious episodes were associated with severe neutropenia. Immunoglobulins were normal in those patients in whom this was done. Bacterial infection was the most common cause of infections in both groups; however, gram negative bacilli (GNB) were found more frequently in the positive than in the negative group. Salmonella septicaemia occurred in one HTLV-positive and one HTLV-negative patient. Fungal infections occurred on 8 (25 percent) and 2 (6 percent) occasions and viral infection on 1 (4 percent) and 2 (9 percent) occasions in HTLV-positive and negative patients respectively. Fungal infection in all but one case confined to skin and buccal cavity in both groups. The one exception had a fungal lung abscess and this was in an HTLV-positive patient. Thus only 4 percent of HTLV-positive patients had systemic opportunistic infections. Scabies occurred in 2 (6 percent) HTLV-positive patients and one (4 percent) HTLV-negative patient. Systemic opportunistic infections are therefore uncommon in Jamaican patients with HTLV-associated lymphoma, unlike the situation in other endemic areas. Death was directly attributable to infection in 8 (35 percent) HTLV-positive and 6 (40 percent) HTLV-negative patients. GNB septicaemia was the most common cause of death in the HTLV-positive group (AU)

Total serum IgE and IgG4 levels in allergic and non-allergic West Indian medical students - abstract

Despite high prevalence rates of allergic illnesses in the region, the laboratory indices of these disorders have not been documented. This prospective controlled study was undertaken to determine the levels of sensitizing antibodies (IgE and IgG4) and their variation over a one-year period. The subjects, 17 allergic and 7 non-allergic pre-clinical medical students and laboratory technologists, were selected by questionnaire. Blood samples were collected at approximately 3-monthly intervals and a stool sample at the beginning of the study. Routine haematological and microbiological investigations were carried out on blood and stool samples respectively. IgE was measured by enzyme immunoassay and IgG4 by radial immunodiffusion. Haematological and coprological investigations were normal in all subjects. Total serum IgE levels were higher in allergic subjects than in controls (geometric means 192ñ4.5 and 77ñ3.5 Ku/1 respectively) and there were no seasonal fluctuations in either group. Both groups had similar IgG4 levels which also showed no seasonal variation (geometric means 0.88ñ2.18 and 1.01ñ1.89g/L respectively). These IgG4 values were elevated in comparison with those reported for Europeans (mean 0.6g/1). The total IgE levels in our study, which were within the normal range for temperate populations, were much lower than those reported for tropical populations. Total serum IgE levels in isolation were unable to distinguish between allergic and non-allergic individuals. There was no evidence of a seasonal allergen. The elevation in IgG4 levels in control and allergic subjects has not been previously reported. Chronic antigenic stimulation is thought to produce elevated IgG4 levels. It is possible that chronic perennial allergenic stimulation may contribute to the raised IgG4 levels found in this study (AU)